Abstract
The management of incidental or unusual site venous thrombosis (VT) is challenging and is often extrapolated from studies on symptomatic deep venous thrombosis (DVT). There is a tendency to treat with anticoagulation, due to the theoretical risk of propagation and embolism; however, this is not without risk. Furthermore, there is little guidance on how to monitor incidental VT. The aim of this study was to describe the natural history of incidental uterine venous plexus thrombosis (UVPT) and provide a structured approach to its overall management. A prospective study was conducted in a university teaching hospital over a 16-month period. Women diagnosed with UVPT on transvaginal ultrasound (TVS) were followed up over a six-month period and managed based on an individualised risk assessments, in conjunction with haematologists. Fifty women were diagnosed with UVPT during the study period, of which 38 were managed expectantly. The resolution was documented in 70% of women. There were no cases of symptomatic DVT or pulmonary embolisms in either the expectant or treatment groups. Our study has shown that in a high proportion of women, incidental UVPT could be managed successfully without the need for anticoagulation. The overall management of UVPT should be based on individualised clinical risk assessments.
Highlights
Management of incidental, asymptomatic venous thrombosis (VT), or unusual siteVT, remains challenging and there are no substantive data to guide whether or not anticoagulation is required
Studies have shown that the risk of propagation and embolism is low with incidental calf deep venous thrombosis (DVT) [1], management is often extrapolated from studies on symptomatic DVT
Given the paucity of data on uterine venous plexus thrombosis (UVPT), there has been a tendency to treat with anticoagulation [3,4], in women considered to be at a potentially higher risk of venous thromboembolism (VTE), for example women who became pregnant during follow up or are due to have surgery or long-haul travel [4]
Summary
Management of incidental, asymptomatic venous thrombosis (VT), or unusual siteVT, remains challenging and there are no substantive data to guide whether or not anticoagulation is required. Studies have shown that the risk of propagation and embolism is low with incidental calf deep venous thrombosis (DVT) [1], management is often extrapolated from studies on symptomatic DVT. UVPT can present clinicians with a management dilemma. Such thrombosis can theoretically embolise into the pulmonary circulation, remain insitu, and evolve into pelvic phleboliths (or act as a precursor for valvular incompetence, leading to pelvic varicosities). Given the paucity of data on UVPT, there has been a tendency to treat with anticoagulation [3,4], in women considered to be at a potentially higher risk of venous thromboembolism (VTE), for example women who became pregnant during follow up or are due to have surgery or long-haul travel [4]
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