Should we diagnose and treat distal deep vein thrombosis?
| Autor: | Marc Philip Righini, Helia Robert-Ebadi |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Deep vein MEDLINE 030204 cardiovascular system & hematology Placebo law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law medicine Humans Venous Thromboembolism/diagnostic imaging/drug therapy Registries cardiovascular diseases 030212 general & internal medicine Randomized Controlled Trials as Topic Venous Thrombosis ddc:616 Venous Thrombosis/diagnostic imaging/drug therapy business.industry Anticoagulants Cancer Venous Thromboembolism Hematology medicine.disease Thrombosis Surgery Pulmonary embolism medicine.anatomical_structure Anticoagulants/therapeutic use Controversies in Venous Thromboembolism: To Treat or Not to Treat business Venous thromboembolism |
| Zdroj: | Hematology Oncology Clinics of North America, Vol. 2017, No 1 (2017) pp. 231-236 |
| ISSN: | 1520-4383 1520-4391 0889-8588 |
| DOI: | 10.1182/asheducation-2017.1.231 |
| Popis: | Ultrasound series report that isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower-limb DVTs and, therefore, is a frequent medical condition. Unlike proximal DVT and pulmonary embolism, which have been studied extensively and for which management is well standardized, much less is known about the optimal management of isolated calf DVT. Recent data arising from registries and nonrandomized studies have suggested that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated. These data had some impact on the international recommendations that recently stated that ultrasound surveillance instead of systematic therapeutic anticoagulation might be an option for selected low-risk patients. However, robust data from randomized studies are scarce. Only 5 randomized trials assessing the need for anticoagulation for calf DVT have been published. Many of these trials had an open-label design and were affected by methodological limitations. The only randomized placebo-controlled trial included low-risk patients (outpatients without cancer or previous venous thromboembolism [VTE]) and was hampered by limited statistical power. Nevertheless, data from this trial confirmed that the use of therapeutic anticoagulation in low-risk patients with symptomatic calf DVT is not superior to placebo in reducing VTE but is associated with a significantly higher risk of bleeding. Further randomized studies are needed to define the best therapy for high-risk patients (inpatients, patients with active cancer, or patients with previous VTE) and the optimal dose and duration of treatment. |
| Databáze: | OpenAIRE |
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