The aim of this study was to evaluate different durations of treatment in patients with calf venous thrombosis (CVT) involving 1 or more deep veins. The authors studied 2 groups of patients with postsurgical CVT diagnosed by echo-color Doppler. The first group consisted of 68 patients with CVT involving a single vein, and the second group consisted of 124 patients with CVT involving 2 or more veins. Immediately after diagnosis, all patients were treated with nadroparin calcium and sodium warfarin. Heparin treatment was withdrawn after 5–6 days of treatment, when the international normalized ratio (INR) was stabilized between 2 and 3. Each group was divided into 2 subgroups receiving anticoagulation treatment for 6 or 12 weeks, respectively. The endpoint was proximal extension of the thrombotic lesion, defined as the extension of the thrombus to the popliteal and/or femoral vein. In patients with single-vessel CVT there was no significant difference between the 2 subgroups, whereas in patients with CVT involving 2 or more vessels, a statistically significant difference was observed, the number of cases showing proximal extension of the thrombus being higher among patients treated for 6 weeks. Twelve weeks of anticoagulation treatment is better than 6 weeks only in patients with postsurgical CVT involving 2 or more veins.
Get full access to this article
View all access options for this article.
References
1.
Giachino A: Relationship between deep-vein thrombosis in the calf and fatal pulmonary embolism. Can J Surg31:129-130, 1988.
2.
Ohgi S, Tachibana M, Ikebuchi M, et al: Pulmonary embolism in patients with isolated soleal vein thrombosis. Angiology49:759-764, 1998.
3.
Gottlieb RH, Widjaja J, Mehrs S, et al: Clinically important pulmonary emboli: Does calf vein US alter outcomes?Radiology211:25-29, 1999.
4.
Kazmers A, Groehn H, Meeker C: Acute calf vein thrombosis: Outcomes and implications. Am Surg65:1124-1127, 1999.
5.
Guias B, Simoni G, Oger E, et al: Calf muscle venous thrombosis and pulmonary embolism. J Mal Vasc24:132-134, 1999.
6.
Meissner MH, Caps MT, Bergelin RO, et al: Early outcome after isolated calf vein thrombosis. J Vasc Surg26:749-756, 1997.
7.
Krunes U, Teubner K, Knipp H, et al: Thrombosis of the muscular calf veins-references to a syndrome, which receives little attention. Vasa27:172-175, 1998.
8.
Hollerweger A, Macheiner P, Redenbacher T, et al: Sonograpohic diagnosis of thrombosis of the calf muscle veins and the risk of pulmonary embolism. Ultraschall Med21:66-72, 2000.
9.
Baumgartner I, Braunschweig M, Triller J, et al: Power-based colour coded duplex sonography for evaluation of calf veins. Int Angiol17:43-48, 1998.
10.
Forbes K, Stevenson AJ: The use of power Doppler ultrasound in the diagnosis of isolated deep venous thrombosis of the calf. Clin Radiol53:752-754, 1998.
11.
Gottlieb RH, Widjaja J, Tian L, et al: Calf sonography for detecting deep venous thrombosis in symptomatic patients. experience and review of the literature. J Clin Ultrasound27:415-420, 1999.
12.
Meissner MH: Duplex follow-up of patients with DVT. does it have clinical significance?Semin Vasc Surg14:215-221, 2001.
13.
Wells PS, Lensing AWA, Davidson BL, et al: Accuracy of ultrasound for the diagnosis of deep vein thrombosis in asymptomatic patients after orthopedic surgery. Ann Intern Med122:47-53, 1995.
14.
Bosson JL, Riachi M, Pichot O, et al: Diameters of acute proximal and distal deep venous thrombosis of the lower limbs. Int Angiol17:260-267, 1998.
15.
Barradel LB, Buckley MM: Nadroparin calcium: A review of its pharmacology and clinical applications in the prevention and treatment of thromboembolic disorders. Drugs44:858-888, 1992.
16.
Diquelou A, Dupouy D, Cariou R, et al: A comparative study of the anticoagulant and anti-thrombotic effects of unfractionated heparin and a low molecular weight heparin (Fraxiparine) in an experimental model of human venous thrombosis. Thromb Haemost74:1286-1292, 1995.
17.
Hirsh J: Comparison of the relative efficacy and safety of low molecular weight heparin and unfractionated heparin for the treatment of venous thrombosis. Haemostasis26:189-198, 1996.
18.
Davis R, Faulds D: Nadroparin calcium. A review of its pharmacological and clinical use in the prevention and treatment of thromboembolic disorders. Drugs Aging10:299-322, 1997.
19.
Stricker H, Marchetti O, Haeberli A, et al: Hemostatic activation under anticoagulant treatment: A comparison of unfractionated heparin vs Nadroparin in the treatment of proximal deep vein thrombosis. Thromb Haemost82:1227-1231, 1999.
20.
Breddin HK: Low molecular weight heparins in the prevention of deep-vein thrombosis in general surgery. Semin Thromb Hemost25:83-89, 1999.
21.
Egger B, Schmid SW, Naef M, et al: Efficacy and safety of weight-adapted nadroparin calcium vs heparin sodium in prevention of clinically evident thromboembolic complications in 1,990 general surgical patients. Dig Surg17:602-609, 2000.
22.
PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis. JAMA263:2753-2759, 1990.
23.
van Beek EJR, Kuyer PMN, Schenk BE, et al: A normal perfusion lung scan in patients with clinical suspected pulmonary embolism. Frequency and clinical validity. Chest108:170-173, 1995.
24.
Miniati M, Pistolesi M, Marini C, et al (The PISA-PED Investigators): Value of perfusion lung scan in the diagnosis of pulmonary embolism. Results of the Prospective Investigative Study of Acute Pulmonary Embolism. Diagnosis. Am J Crit Care Med154:1387-1393, 1996.
25.
de Grooth MR, Turkstraa F, van Marwijk Kooy M, et al: Value of chest x-ray combined with perfusion scan versus ventilation/perfusion scan in acute pulmonary embolism Thromb Hemost83:412-415, 2000.
26.
Favretto G: A proposito di scintigrafia polmonare nella diagnosi di embolia polmonare. Ital Heart J3(suppl):95-99, 2002.
27.
Pinede L, Ninet J, Duhaut P, et al: 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. Circulation103:2453-2460, 2001.
28.
Pinede L, Cucherat M, Duhaut P, et al: Optimal duration of anticoagulant therapy after an episode of venous thromboembolism. Blood Coagul Fibrinolysis11:701-707, 2000.
29.
Astermark J, Bjorgell O, Linden E, et al: Low recurrence rate after deep calf-vein thrombosis with 6 weeks of oral anticoagulation. J Intern Med244:79-82, 1998.
30.
Pellegrini VD Jr, Clement D, Lush-Ehmann C, et al: The John Charnley Award. Natural history of thromboembolic disease after total hip arthroplasty. Clin Orthop333:27-40, 1966.
31.
Ferrara F, Meli F, Raimondi F, et al: Incidence of proximal extension of thrombotic lesions and pulmonary embolism in untreated patients with calf vein thrombosis. Haematologica88:1-1, 2003.
32.
Pinede L: Duration of oral anticoagulant therapy in deep venous thrombosis of the lower limbs. Ann Cardiol Angeiol51:158-163, 2002.
