Therapy of isolated calf muscle vein thrombosis: A randomized, controlled study

Schwarz, Thomas; Buschmann, Lutz; Beyer, Jan; Halbritter, Kai; Rastan, Aljoscha; Schellong, Sebastian

doi:10.1016/j.jvs.2010.05.094

Cited by 125 publications

(134 citation statements)

References 19 publications

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“…In the first study, 49 they found few complications in patients receiving therapeutic doses of LMWH for 10 days plus compression therapy vs those receiving compression alone. In the second, 4 no difference in 3-month progression rates was detected in low-risk patients randomized to 10 days of therapeutic LMWH doses and compression therapy or to compression therapy only. Finally, a very high rate of muscle vein thrombosis was recorded in a study involving patients who were hospitalized, and so whom by definition were at higher risk.…”

Section: What Is Done In Studies and In Clinical Practicementioning

confidence: 90%

“…[2][3][4] Special anatomical features of muscle vs deep veins may plausibly account for some of the differences. First, their diameter and length are smaller, which means the thrombus volume is smaller too; furthermore, soleal veins are connected with distal deep veins, instead of with popliteal veins, and so are farther away from proximal veins.…”

Section: Muscular or Deep Calf Vein Thrombosesmentioning

confidence: 99%

“…4,23 The patients undergo US examination at the end of anticoagulation to assess IDDVT evolution, to have a basal picture of deep calf veins in the case new symptoms/signs have occurred, suggesting possible DVT recurrence.…”

Section: How I Treat Iddvtmentioning

confidence: 99%

“…Although some authors [2][3][4] claim that isolated calf muscle vein thrombosis (ICMVT) should be distinguished from IDDVT (thrombosis in the paired veins), most clinical contributions consider these anatomically distinct veins as a whole (and refer to them as IDDVT).…”

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confidence: 99%

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How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

102

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Thromboses limited to infrapopliteal leg deep veins (isolated distal deep vein thrombosis [IDDVT]) are frequently diagnosed in subjects with suspected pulmonary embolism or DVT and account for one-fourth to one-half of all diagnosed leg DVTs. Despite their frequency, the natural history of IDDVTs and their real risk of thromboembolic complications are still uncertain because of the scarcity of prospective, blind, nonintervention studies. Therefore it is still debated whether they warrant diagnosis and treatment. Diagnosis is based on ultrasonographic examination, which is more operator dependent and less sensitive in distal than in proximal veins. The available data seem to support the view that most IDDVTs are self-limiting and inconsequential for patients, though in some cases they can be associated with complications and warrant diagnosis and treatment. The available guidelines for treatment of IDDVTs give different indications ranging from serial imaging of the deep veins for 2 weeks to detect and treat only in case of proximal extension, to giving oral anticoagulation in all IDDVT patients for 3 months. I review this issue, focusing on possible and suggested treatments in symptomatic IDDVT patients, and describe our current therapeutic approach to these patients.

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Section: What Is Done In Studies and In Clinical Practicementioning

confidence: 90%

Section: Muscular or Deep Calf Vein Thrombosesmentioning

confidence: 99%

Section: How I Treat Iddvtmentioning

confidence: 99%

mentioning

confidence: 99%

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How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

102

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“…Controversy exists over whether to anticoagulate deep muscular vein thromboses. No large randomized trials have been done, and some smaller studies show similar resolution with or without anticoagulation [1,2]. Thus, the decision to continue subcutaneous (SC) prophylactic-dose heparin was reasonable.…”

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confidence: 99%

Non–injection‐site necrotic skin lesions complicating postoperative heparin thromboprophylaxis

Tassava

Warkentin

2015

American J Hematol

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A 75-year-old African-American man with Type II diabetes, hypertension, and hyperlipidemia was admitted with a painful right leg secondary to bilateral iliac artery obstruction. Admission hemoglobin level was 14.4 g/dL, white blood count was 11.9 3 10 9 /L (neutrophils, 10.4 3 10 9 /L), and the platelet count was 366 3 10 9 /L. Unfractionated heparin 5,000 IU thrice daily by subcutaneous injection was given for 5 days. Aortobifemoral bypass surgery was performed with full-dose intravenous heparin followed by daily subcutaneous unfractionated heparin thromboprophylaxis. After an initial decline, the platelet count rose to 480 3 10 9 /L on postoperative Day 4 (Day 10 after start of preoperative course of heparin), at which time the patient developed a swollen right leg. Vascular duplex revealed a gastrocnemius vein clot of indeterminate age, which was not treated.This patient was found to have a gastrocnemius vein thrombosis on Day 4 after surgery. Controversy exists over whether to anticoagulate deep muscular vein thromboses. No large randomized trials have been done, and some smaller studies show similar resolution with or without anticoagulation [1,2]. Thus, the decision to continue subcutaneous (SC) prophylactic-dose heparin was reasonable.On postoperative Day 5, a right leg patchy retiform purpuric skin rash developed (Fig. 1A). Arterial duplex showed improved but still poor arterial flow to the right leg. Skin biopsy (right medial thigh) showed intravascular thrombus in a mid-dermal vessel and partial epidermal necrosis, without vasculitis (Fig. 1B,C). Laboratory investigations, including complete blood count, measurement of antithrombin, protein C, protein S, ANCA, cryoglobulins, homocysteine, viral hepatitis serology, complement, and antiphospholipid antibodies, were normal/ negative. The necrotic skin rash was considered secondary to "transient ischemia" during the preceding vascular surgery. The patient was discharged to a rehabilitation facility off heparin.The patient's right lower limb rash included multiple discrete lesions extending from the thigh to the ankle with blisters, SC hemorrhage, and necrosis in an angulated branched configuration described as "retiform purpura." These lesions have a broad differential, including vasculitis, hypercoagulable state, purpura fulminans, cholesterol embolism, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, warfarin-induced skin necrosis, heparin-induced skin necrosis, cryoglobulinemia, and calciphylaxis [3][4][5]. The biopsy finding of epidermal necrosis and intravascular thrombus without vasculitis, calcification, or inflammatory cell infiltrate, plus the negative hypercoagulability testing, lack of infection, renal failure, hemolysis, and absence of warfarin therapy, rules out most of these entities. Additionally, skin necrosis from low blood flow alone can be seen in livedo racemosa, but this entity is accompanied by a perilesional violaceous reticulated skin discoloration, which was not seen [3,4].Our patient had received SC inj...

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