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A Wolf in Sheep's Clothing?

John T. Philbrick, MD; Daniel M. Becker, MD, MPH

Arch Intern Med. 1988;148(10):2131-2138.

Abstract
• To determine the natural history of calf deep venous thrombosis (C-DVT), an analytic review of the 20 relevant English-language papers published since 1942 was performed. Remarkably little methodologically sound research on this subject was found. However, available evidence suggests that C-DVT propagates to the thigh in up to 20% of cases and that propagation invariably occurs before embolization. No fatal emboli were reported in patients presenting with isolated C-DVT. Traditional anticoagulation treatment with heparin sodium and warfarin sodium of symptomatic patients with C-DVT appears to prevent extension, embolization, and early recurrence. There is no convincing evidence that C-DVT leads to chronic venous insufficiency or whether the risks of anticoagulation exceed the risks of no treatment. As an option to anticoagulation, physicians may choose to follow patients with C-DVT with serial impedance plethysmography, treating only if there is evidence of proximal extension.

(Arch Intern Med 1988;148:2131-2138)

Author Affiliations
From the Division of General Medicine, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.

Footnotes
Accepted for publication May 3, 1988.

Reprint requests to University of Virginia School of Medicine, Box 494, Charlottesville, VA 22908 (Dr Philbrick).

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