Therapy of isolated calf muscle vein thrombosis with low-molecular-weight heparin

Abstract

There are no data from prospective studies concerning the treatment of isolated calf muscle vein thrombosis (soleal and gastrocnemial muscle veins), found in 20-40% of patients with lower extremity thrombosis of the calf. We investigated the outcome in two cohorts of consecutive patients, the first receiving low-molecular-weight heparin for 10 days at therapeutic doses and compression therapy; the second cohort, compression therapy alone. In patients on therapeutic heparin (n = 52), no progression to deep vein thrombosis occurred [0%; 95% confidence interval (CI), 0-6.8%]. Patients without anticoagulation (n = 32) showed a statistically significant higher percentage of progression into the deep calf veins (25%; 95% CI, 11.5-43.4%) as well as recurrent muscle vein thrombosis. No symptomatic pulmonary embolism or bleeding event occurred; one patient died in each group, both related to malignancy. The data suggest a need for short-term anticoagulation in such patients to prevent further thromboembolic complications. Randomized prospective studies are now warranted in a larger study population.

How I treat isolated distal deep vein thrombosis (IDDVT)

“…2,48 Schwarz et al in 2 subsequent studies reported different results. 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.…”

Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

“…Study populations were diverse among these studies. One study was performed totally with inpatients [27], another two consisted of a mixture of outpatients and inpatients [4,14], while the other two did not make clear statements in this regard [5,15]. P atients in the TA groups were treated with various anticoagulant protocols among the studies.…”

“…One of them did not report specifi c anticoagulation drugs [5], and none of the three retrospective studies reported the duration of TA [4,5,27]. Notably, two prospective studies by Schwarz et al applied additional compression stockings in both the TA and control groups [14,15].…”

“…The NRCT had a relatively higher quality, with a score of 20 points. Nevertheless, the NRCT was not blinded to evaluate endpoints and did not prospectively calculate the proper sample size, which may be why no patients developed PE or major bleeding events in the groups in this study [15] (ESM 2). All three retrospective studies were qualifi ed and had the same NOS score of six points.…”

“…Based on study types, these studies were divided into two subgroups, and b oth subgroups showed signifi cant heterogeneity among studies (p = 0.03, I 2 = 80 % and p = 0.04, I 2 = 76 %, respectively; Figure 2A) [4,14,15,27]. Hence, a random-eff ects model was performed to analyze the pooled results, showing an insignifi cant decrease i n the rate of thrombosis progression in both s ubgroups (RR = 0.63, 95 % CI 0.20 to 2.04, p = 0.44 and RR = 0.22, 95 % CI 0.01 to 6.90, p = 0.39, respectively).…”