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Isolated calf deep vein thrombosis in the community setting: the Worcester Venous Thromboembolism study

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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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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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None of the authors have any conflicts of interest to report.

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Authors and Affiliations

  1. Department of Medicine, McMaster University Medical School, Hamilton, ON, Canada

    Frederick A. Spencer & Alla V. Glushchenko

  2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Frederick A. Spencer, Darleen Lessard, Cathy Emery & Joel M. Gore

  3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Aimee Kroll, George Reed & Robert J. Goldberg

  4. Department of Research, Reliant Medical Group, Worcester, MA, USA

    Luigi Pacifico

  5. St. Joseph’s Healthcare, Martha Wing, Room H319, 50 Charlton Avenue East, Hamilton, ON, L8N4A6, Canada

    Frederick A. Spencer

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  1. Frederick A. Spencer
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  2. Aimee Kroll
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  3. Darleen Lessard
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  4. Cathy Emery
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  5. Alla V. Glushchenko
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  7. George Reed
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  8. Joel M. Gore
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  9. Robert J. Goldberg
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Correspondence to Frederick A. Spencer.

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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

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