Mayo Clinic Proceedings Home
MCP Digital Health Home

Calf Vein Thrombosis Outcomes Comparing Anticoagulation and Serial Ultrasound Imaging Management Strategies



      To compare outcomes among patients with calf deep vein thrombosis (DVT) stratified by management strategy because distal or calf DVT is said to have low rates of propagation, embolization, and recurrence and, as such, guideline recommendations include provisions for serial imaging without treatment.

      Patients and Methods

      Consecutive patients with ultrasound-confirmed acute DVT involving the calf veins (January 1, 2016, to August 1, 2018) were identified by scrutinizing the Gonda Vascular Center Ultrasound database. Patients were segregated into 2 categories depending on management strategy; anticoagulation vs serial surveillance ultrasound without anticoagulation. Outcomes including venous thromboembolism (VTE) recurrence, bleeding, death, and net clinical benefit were compared by treatment strategy.


      There were 483 patients with calf DVT identified; 399 were treated with anticoagulation therapy and 84 were managed with surveillance ultrasound. Patients in the surveillance group were older (70.0±13.9 vs 63.0±14.9 years; P<.001) and more likely to have had a recent hospitalization (76.2% [64/84] vs 45.4% [181/399]; P<.001). Common reasons for choosing ultrasound surveillance included guideline prescriptive (58.3% [49/84]), active bleeding (21.4% [18/84]), and recent surgery (17.9% [15/84]). The VTE recurrence composite was lower for patients treated with anticoagulants (7.3% [29/399]) compared with surveillance (14.3% [12/84]; P=.04). The DVT propagation was less frequent in the treated group (2.8% [11/399] vs 8.3% [7/84]; P=.01). There was no difference in bleeding or mortality outcomes by management strategy. Net clinical benefit (VTE recurrence plus major bleeding) favored anticoagulant therapy (9.8% [39/399] vs 20.2% [17/84]; P<.01).


      Patients with calf DVT treated with anticoagulants had significantly better outcomes compared with those managed by a strategy of serial ultrasound surveillance without increasing bleeding outcomes.

      Abbreviations and Acronyms:

      DVT (deep vein thrombosis), LMWH (low-molecular-weight heparin), NSAID (nonsteroidal anti-inflammatory drug), PE (pulmonary embolism), VTE (venous thromboembolism)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kearon C.
        • Akl E.A.
        • Ornelas J.
        • et al.
        Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
        Chest. 2016; 149: 315-352
        • Garry J.
        • Duke A.
        • Labropoulos N.
        Systematic review of the complications following isolated calf deep vein thrombosis.
        Br J Surg. 2016; 103: 789-796
        • Horner D.
        • Hogg K.
        • Body R.
        • Nash M.J.
        • Baglin T.
        • Mackway-Jones K.
        The Anticoagulation of Calf Thrombosis (ACT) project: results from the randomized controlled external pilot trial.
        Chest. 2014; 146: 1468-1477
        • De Martino R.R.
        • Wallaert J.B.
        • Rossi A.P.
        • Zbehlik A.J.
        • Suckow B.
        • Walsh D.B.
        A meta-analysis of anticoagulation for calf deep venous thrombosis.
        J Vasc Surg. 2012; 56: 228-237
        • Schellong S.M.
        Low risk is not enough: the dilemma of calf vein thrombosis.
        Lancet Haematol. 2016; 3: e548-e549
        • Lagerstedt C.I.
        • Olsson C.G.
        • Fagher B.O.
        • Oqvist B.W.
        • Albrechtsson U.
        Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis.
        Lancet. 1985; 2: 515-518
        • Ferrara F.
        • Meli F.
        • Amato C.
        • et al.
        Optimal duration of treatment in surgical patients with calf venous thrombosis involving one or more veins.
        Angiology. 2006; 57: 418-423
        • Schwarz T.
        • Buschmann L.
        • Beyer J.
        • Halbritter K.
        • Rastan A.
        • Schellong S.
        Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study.
        J Vasc Surg. 2010; 52: 1246-1250
        • Righini M.
        • Galanaud J.P.
        • Guenneguez H.
        • et al.
        Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial.
        Lancet Haematol. 2016; 3: e556-e562
        • Kuczmik W.
        • Wysokinski W.E.
        • Hesley G.K.
        • et al.
        Calf vein thrombosis comparison of outcomes for axial and muscular venous thrombosis.
        Thromb Haemost. 2020; 121: 216-223
        • Schulman S.
        • Kearon C.
        • Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis
        Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.
        J Thromb Haemost. 2005; 3: 692-694
        • Kaatz S.
        • Ahmad D.
        • Spyropoulos A.C.
        • Schulman S.
        • Subcommittee on Control of Anticoagulation
        Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH.
        J Thromb Haemost. 2015; 13: 2119-2126
        • Palareti G.
        • Cosmi B.
        • Lessiani G.
        • et al.
        Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study.
        Thromb Haemost. 2010; 104: 1063-1070
        • Hull R.
        • Delmore T.
        • Genton E.
        • et al.
        Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis.
        N Engl J Med. 1979; 301: 855-858