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martes, 13 de diciembre de 2016

Calf Deep Vein Thrombosis

E.E.B.E.L.EM - Posted by Salim Rezaie - December 12, 2016
Background: The optimal management of isolated calf deep vein thrombosis (DVT) is not completely clear, based on the available evidence. The authors of this paper state up to 50% of all lower extremity DVTs are infra-popliteal. Because there is not a lot of robust evidence to guide us on the best diagnostic and therapeutic treatments, a huge variation in practice is seen. To help try and answer these questions the authors of this paper performed the Compression versus Anticoagulant treatment and compression in symptomatic Calf Thrombosis diagnosed by UltraSound – CACTUS Trial.
Author Conclusion: “Nadroparin was not superior to placebo in reducing te risk of proximal extension or venous thromboembolic events in low-risk outpatients with symptomatic calf DVT, but did increase the risk of bleeding. Avoidance of systematic anticoagulation for calf DVT could have a substantial impact on individual patients from a public health perspective.”
Clinical Take Home Point: This is an underpowered study, that gives us very little guidance on how to treat distal calf DVTs. As there is no clear optimal approach at this time, I would advocate for a shared decision making strategy regarding the use of anticoagulation vs no anticoagulation in isolated low-risk, distal DVTs. With either strategy, close follow up with repeat ultrasound, over the next few days, should be performed to assist with further management and treatment decisions.