Calf Vein Clots

Podcast with Tom Deloughery on calf clots and superficial thrombphlebitis

References for Grand Rounds Lecture

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Masuda, Elna M., et al. “The controversy of managing calf vein thrombosis.” Journal of vascular surgery 55.2 (2012): 550-561.

Ferrara, Filippo, et al. “Optimal duration of treatment in surgical patients with calf venous thrombosis involving one or more veins.” Angiology 57.4 (2006): 418-423.

Galanaud, J‐P., et al. “Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis.” Journal of Thrombosis and Haemostasis 12.4 (2014): 436-443.

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Lagerstedt, ClaesI, et al. “Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis.” The Lancet 326.8454 (1985): 515-518.

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Palareti, Gualtiero. “How I treat isolated distal deep vein thrombosis (IDDVT).” Blood 123.12 (2014): 1802-1809.

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Pinede, Laurent, et al. “Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis.” Circulation 103.20 (2001): 2453-2460.

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Olson, Erik J., et al. “Below-knee deep vein thrombosis: An opportunity to prevent pulmonary embolism?.” Journal of Trauma and Acute Care Surgery 77.3 (2014): 459-463.

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  1. don zweig

    rob, can you or Tom opine on this case. 55yo male presents with left leg pain just above the knee on medial thigh. 6 mos ago he had a dvt post operatively in that leg. the images are not available. he has been on coumadin since with uncertain compliance. he also has left chest pain that is worse with deep breath and palpation. his inr is 2.7 and d dimer is normal. the doppler shows definite clot of uncertain age in left pop fossa. cTa is neg for embolus.

    ?1, is the d dimer affected by anticoagulation?
    ?2. would you change treatment since this could be warfarin failure?

    Don Zweig

    1. Post
      Rob Orman

      Here is the response from Tom Deloughery….My take is that anticoagulation effects the D-dimer by suppressing anticoagulation – so if you are ‘breaking through” warfarin the D-dimer should be up. Always nice to have old films to see if the knee clot is old but based on this history and the location of the pain I would just stick with warfarin – If he is non-compliant because of monitoring issues than can use DOACS

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