Management of isolated soleal and gastrocnemius vein thrombosis

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The ideal treatment for hospitalized patients with isolated gastrocnemius and/or soleal venous thrombosis is unclear. Recommendations range from watchful waiting to full-dose anticoagulation. This study examines the effectiveness of practice patterns at a single institution as measured by progression of thrombus. All consecutive inpatients with a duplex scan diagnosis of isolated gastrocnemius and/or soleal vein clot (no other thrombotic segments were identified) and where two consecutive duplex studies (Intersocietal Commission for the Accreditation of Vascular Laboratories laboratory) were available for review were included. Two study groups were identified. TX group included patients who received anticoagulation treatment (heparin [fractionated or unfractionated], heparin substitutes, or warfarin) and the NoTX group included those who did not receive anticoagulant. Demographic, risk factors, comorbidities, length of hospital and intensive care unit stay, ambulatory status, and underlying hypercoagulable states were recorded. Thrombus progression rate in the two groups was compared using the χ2 test. A multivariate logistic regression model was used to examine the effect of anticoagulation treatment as well as the above demographic and clinical factors on the risk of progression. A total of 141 patients were included in the study, 76 of whom (54%) received anticoagulation. Forty-three patients (30%) had progression of their venous thrombosis: 33% (25/76) in the TX group and 28% (18/65) in the NoTX group (P=.50, by χ2 test). Results from multivariate logistic regression showed that treatment had no significant impact on outcome (Odds ratio=1.28, 95% confidence interval: 0.55-3.01; P=.57]. Patients with end-stage renal disease (6%), or stroke (13%) had significantly higher risk of progression (P<.05). None of the other clinical or demographic factors were significantly associated with the risk of progression. The results speak to the lack of efficacy of anticoagulation in the management of gastrocnemius and/or soleal vein thrombosis in the hospitalized patient. When measured by thrombus progression, treating these patients without anticoagulation appears to be equally efficacious as subjecting patients to anticoagulant therapy. A prospective, randomized clinical trial will be an important step in fully addressing this clinical dilemma.