Management of isolated calf vein thrombosis

ObjectiveThe aim of the present study was to evaluate a protocol for managing isolated calf vein thrombosis.BackgroundDeep vein thrombosis (DVT), which is common among the general population, can lead to fatal pulmonary embolism; therefore, its early diagnosis is essential. A recent study revealed that the reason for 10% of mortality in general hospitals in the UK was pulmonary embolism.Patients and methodsForty patients with isolated calf vein thrombosis were categorized into two groups: group A, which included 20 patients with provoked isolated calf vein thrombosis; and group B, which included 20 patients with unprovoked isolated calf vein thrombosis.ResultsIn the provoked group, 16 patients had satisfactory resolution after 10 days of therapy (80%), four patients had no resolution (20%), and no patient had progression to the popliteal vein. On the other hand, in the unprovoked group, 14 patients had satisfactory resolution (70%), four patients had no resolution (20%), and two patients had progression to the popliteal vein (10%) (P = 0.34). Sixteen patients in the provoked group had no recurrence at the end of 3 months (80%), three patients had recurrence of the calf thrombosis (15%), and one patient had progression to the popliteal vein (5%), whereas in the unprovoked group, 14 patients had no recurrence (70%), four patients had recurrence of calf thrombosis (20%), and two patients had progression to the popliteal vein (10%) (P = 0.74).ConclusionProvoked calf vein thrombosis can be treated with low molecular weight heparin (LMWH) for 10 days and then the duplex should be repeated after 10 days. If there is no progression to thrombus, anticoagulation therapy is stopped and the patient is asked to use elastic stockings. Unprovoked calf vein thrombosis can be treated with LMWH for 10 days, and if there is no propagation to the thrombus, we can put the patients on low intensity warfarin dose regimen - for example, 1-2 mg to adjust INR in the range 1-1.9.