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Isolated Soleal and Gastrocnemius Vein Thrombosis Revisited: The Proper Treatment
Ali Elfandi, MD, Clifford M. Sales, MD, Scott Sundick, MD, Sharen Anghel, MD, Rami Bustami, PhD.
Overlook Medical Center, Summit, NJ, USA.

OBJECTIVES: We have advocated for the “non-anticoagulant” approach to the management of isolated soleal or gastrocnemius vein thrombosis (ISGVT) showing that the addition of therapeutic anticoagulation does not affect the rate of propagation of thrombi in these vessels. Our original report was based on data through 2009. The current report re-examines our more current data for the calendar year 2013.
METHODS: All in-patients with a diagnosis of ISGVT made in our ICAVL noninvasive laboratory were included for review. Only those with a follow-up duplex examination were included in the statistical analysis. Review of the medical record data and of the duplex ultrasound examinations allowed for the determination of progression of thrombosis
RESULTS: 100 patients were found to have ISGVT in 2013 at our institution_56 (56%) had a follow-up duplex study available for review and constitute the study group. 32% (n=18) were treated with full-dose anticoagulation (TX group) following the diagnosis of ISGVT. Compared to our historical control (54% had been so treated in our prior report) this represented a significant change in practice pattern (p=.006 .) There were no statistical differences between those in the TX group and those in the NoTX group (those not treated with full-dose anticoagulation) in terms of demographics, risk factors or comorbities. Two of the 18 patients in the TX group (11%) and 6/38 (16%) in the NoTX group had propagation of their ISGVT (p=1.00)_all of which propagated to tibial vessels.
CONCLUSIONS: We repeat our strong support for the avoidance of full-dose anticoagulation in the management of ISGVT. This data shows that propagation is related to factors other than treatment protocols and the addition of therapeutic anticoagulation only exposes patients to the risks of this treatment without proven benefit. We are impressed to see that the medical staff in our institution has apparently accepted this information and has begun to alter their practice patterns.

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