Anticoagulation Reduces the Risk of Thrombus Recurrence and is Associated with Resolution in Isolated Calf Deep Vein Thrombosis

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Introduction - Isolated calf deep vein thrombosis (ICDVT) is common in clinical practice; however, the treatment of ICDVT remains controversial. The current recommendations range from watchful waiting to full-dose anticoagulation. The purpose of the present study was to investigate thrombotic events and identify the risk factors associated with ICDVT during a 1-year follow-up. Methods - A retrospective chart review was performed for patients with ICDVT in a single institution between 2013 and 2014. Diagnosis was established with duplex ultrasound (DUS) examination. All deep veins in the calf, excluding the anterior tibial vein, were examined. We evaluated patients who were followed up clinically and who underwent DUS at 1, 3, and 6 months, and up to 12 months. After initial diagnosis of ICDVT, patients were started on full-dose anticoagulation and compression. The outcomes examined were persistence, re-thrombosis, proximal vein propagation and resolution of ICDVT. Baseline characteristics, including age, sex, asymptomatic status, post operation status, cancer, chemotherapy, steroid use, compression and anticoagulation were analyzed to determine whether they were predictors of thrombus status during a follow-up period. Results - The study included 198 limbs of 145 patients (107 women and 38 men). Fifty-three patients had bilateral ICDVT. The mean age of the patients was 75.3 ± 9.2 years (range, 42-93 years). Most of the patients were asymptomatic (114 patients, 78.6%). Among the 145 patients, 96 (66.2%) received anticoagulation, and 113 (77.9%) received compression. Complete resolution of ICDVT was observed in 49 limbs (24.7%), while 79 limbs (40%) showed persistence, 59 limbs (29.8%) showed re-thrombosis, and 11 limbs (5.5%) showed proximal vein propagation in the calf. Univariate analysis confirmed that non-anticoagulation was associated with patients who developed proximal vein propagation and re-thrombosis (P < .05). Additionally, anticoagulation was associated with patients who showed ICDVT resolution (P < .05). Conclusion - In our study, anticoagulation prevented proximal vein propagation and re-thrombosis and helped in ICDVT resolution. Further evaluations will be needed to identify the patients with ICDVT, who merit receiving anticoagulation.