Propagation of Tibial Vein Thrombus in Patients Systemically Anticoagulated or Receiving Antiplatelet Therapy

Abstract

The objective of this study was to evaluate the incidence of infrapopliteal deep vein thrombus propagation in postoperative orthopedic patients. This was a retrospective study of patients undergoing noninvasive venous testing to rule out phlebothrombosis. Venous duplex scans and Doppler studies to record thrombus location were performed at the end of treatment, which lasted from 2 weeks to 1 year (mean: 6 months). The study included 28 postoperative orthopedic patients; 21 men and seven women with a mean age of 52 years (range: 14 to 92 years). Patients received three different treatment regimens. Group I received heparin and warfarin (n = 17; 60.7%); Group II received warfarin (n = seven; 25%); Group III received aspirin (n = four; 14.3%).

Isolated tibial vein thrombosis was found in 10 patients, (36%) and 18 patients (64%) exhibited multiple tibial veins involvement. Follow-up venous duplex and Doppler studies revealed a single episode (5.9%) of thrombus propagation from an isolated tibial vein to multiple tibial veins in Group I. There were four Group II patients with isolated and three with multiple tibial vein thrombi. Clot propagation occurred in three (42.9%) instances; two originated from isolated tibial vein thromboses and all extended into the popliteal and femoral veins. No propagation occurred in the limbs of Group III. Statistical analysis of treatment protocols revealed a significant difference in outcome (clot propagation) based on management. Warfarin therapy alone (Group II) resulted in a significantly increased risk for clot propagation (p < 0.04), whereas there was no difference in the incidence of clot propagation based on the number of involved tibial veins (p < 0.12).

Warfarin treatment alone was not found to be an effective method of preventing thrombus propagation in postoperative orthopedic patients with tibial vein thrombosis. The treatments using heparin/warfarin or aspirin alone were found to be equally effective for preventing this complication.

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