Arjun Jayaraj, Brenda Zierler, Mark Meissner
University of Washington, Seattle, WA.
OBJECTIVES: Deep vein thrombosis (DVT) involving calf veins is relatively common condition with an incidence of almost 2% in the general population. Despite this high incidence there is lack of consensus regarding appropriate management of the condition borne primarily from paucity of evidence. Our objective as a prelude to a larger randomized trial was to review current management practices by means of a national survey.
METHODS: The survey was conducted among vascular specialists who routinely manage patients with calf DVT. This was done by means of a 19 point questionnaire. The 110 responses accrued were collated and analyzed to ascertain practice patterns.
RESULTS: Of the 110 practitioners 68 (62%) were Vascular Surgeons. Amongst the responders, while 93 (85%) would anticoagulate for axial calf vein DVT, only 60 (55%) would anticoagulate for muscular calf vein DVT. Of those practitioners anticoagulating for calf DVT 60% would follow patients with duplex surveillance compared to 70% in the no anticoagulation group. There was significant variation in timing and duration of duplex surveillance for those not anticoagulated (Day 3 to day 14). Among those who used duplex surveillance only 47% had a protocol for surveillance. Safety of anticoagulation, risk of development of post thrombotic syndrome and quality of life were the key criteria that factored into prescription of anticoagulation. Majority of respondents felt that use of anticoagulation could prevent progression of calf vein DVT. 79% of respondents felt that appropriateness of anticoagulation for calf DVT needed to be addressed with a well-designed trial.
CONCLUSIONS: Currently there does not appear to be consensus regarding the role of anticoagulation following diagnosis of calf deep vein thrombosis. Additionally, the ideal pattern of surveillance following diagnosis of DVT also needs to be clarified. These are questions best answered by a well-designed randomized trial.
AUTHOR DISCLOSURES: A. Jayaraj, Nothing to disclose; M. Meissner, Nothing to disclose; B. Zierler, Nothing to disclose.
Posted April 2012