Abstract
The prevalence of isolated calf deep vein thrombosis (DVT) in the community setting is relatively unexplored. Confusion remains with regards to its management and contemporary natural history. The purpose of this investigation was to describe the number of cases of calf DVT in the community, use of early management strategies, and rates of venous thromboembolism (VTE) recurrence and major bleeding. The medical records of residents of the Worcester (MA) metropolitan area with ICD-9 codes consistent with potential VTE during 4 study years (1999/2001/2003/2005) were validated by trained nurses. Patient demographic/clinical characteristics, treatment practices, and outcomes were evaluated. Isolated calf DVT was diagnosed in 166 (11.1%) of 1,495 patients with lower extremity DVT. Patients with calf DVT were less likely to be discharged on anticoagulants or with an IVC filter than patients with proximal DVT (84.1 vs. 92.3%). The rates of VTE recurrence and pulmonary embolism did not differ significantly between patients with calf DVT and proximal DVT at 6 months (11.0 vs. 8.7%, 2.6 vs. 1.8%, respectively). Patients with calf DVT had higher adjusted risk of early (14-day) VTE recurrence/extension (OR 2.34, 95% CI 1.01–5.44). Patients with calf DVT had lower rates of major bleeding at 6 months compared to patients with proximal DVT (5.2 vs. 9.3%, P = 0.04). Rates of recurrent VTE and major bleeding following calf DVT in the community are much higher than in randomized clinical trials of patients with proximal or calf DVT. Further study of management strategies for isolated calf DVT is needed.
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References
Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U (1985) Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 2:515–518
Lohr JM, Kerr TM, Lutter KS, Cranley RD, Spirtoff K, Cranley JJ (1991) Lower extremity calf thrombosis: to treat or not to treat? J Vasc Surg 14:618–623
Labropoulos N, Kang SS, Mansour MA, Giannoukas AD, Moutzouros V, Baker WH (2002) Early thrombus remodelling of isolated calf deep vein thrombosis. Eur J Vasc Endovasc Surg 23:344–348
Moreno-Cabral R, Kistner RL, Nordyke RA (1976) Importance of calf vein thrombophlebitis. Surgery 80:735–742
Partsch H (2001) Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation. Vasa 30:195–204
Cogo A, Lensing AW, Koopman MM et al (1998) Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 316:17–20
Birdwell BG, Raskob GE, Whitsett TL et al (1998) The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med 128:1–7
Spencer FA, Emery C, Joffe SW et al (2009) Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis 28:401–409
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III (1998) Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 158:585–593
Schulman S, Kearon C (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694
Palareti G, Cosmi B, Lessiani G et al (2010) Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost 104:1063–1070
Lohr JM, Fellner AN (2010) Isolated calf vein thrombosis should be treated with anticoagulation. Dis Mon 56:590–600
Masuda EM, Kistner RL (2010) The case for managing calf vein thrombi with duplex surveillance and selective anticoagulation. Dis Mon 56:601–613
Bernardi E, Camporese G, Buller HR et al (2008) Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. Jama 300:1653–1659
Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ (2008) Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:454S–545S
Decousus H, Leizorovicz A, Parent F et al (1998) A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 338:409–415
Fiessinger JN, Huisman MV, Davidson BL et al (2005) Ximelagatran vs low-molecular-weight heparin and warfarin for the treatment of deep vein thrombosis: a randomized trial. JAMA 293:681–689
Buller HR, Davidson BL, Decousus H et al (2004) Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 140:867–873
Pinede L, Ninet J, Duhaut P et al (2001) Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation 103:2453–2460
Schulman S, Rhedin AS, Lindmarker P et al (1995) A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. N Engl J Med 332:1661–1665
Hansson PO, Sorbo J, Eriksson H (2000) Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 160:769–774
Heit JA, Mohr DN, Silverstein MD, Petterson TM, O’Fallon WM, Melton LJ 3rd (2000) Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 160:761–768
Acknowledgments
Dr. Spencer was supported by Team Grant #154190, Studies in Venous Thromboembolism, Canadian Institutes of Health Research. This study was supported by a grant from the National Heart, Lung, and Blood Institute (R01-HL70283). Dr. Spencer is also supported by a Career Investigator Award from the Ontario Heart and Stroke Foundation. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Frederick Spencer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was made possible by the cooperation of administrators, physicians, and medical records personnel in 12 central Massachusetts hospitals.
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Spencer, F.A., Kroll, A., Lessard, D. et al. Isolated calf deep vein thrombosis in the community setting: the Worcester Venous Thromboembolism study. J Thromb Thrombolysis 33, 211–217 (2012). https://doi.org/10.1007/s11239-011-0670-x
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DOI: https://doi.org/10.1007/s11239-011-0670-x