title: Update on distal deep venous thrombosis. Reports of a multicenter study.
abstract: OBJECTIVE
  No study of strong methodology could be found to resolve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive evidence exists on two approaches to care: anticoagulants and compression therapy or compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein in 8% of patients without anticoagulant treatment, while a complete thrombus resolution within 4 weeks occurred in 20% of patients. We report data of a study conducted in patients affected by DDVT and treated with nadroparin administered once daily in association with compression therapy.
  
  
  METHODS
  One hundred and ten patients with DDVT of the gastrocnemius or tibial veins, assessed by Duplex scanning, were enrolled in 8 clinical centres of the Lazio Region. At baseline, patient demographics, medical history (including risk factors for DDVT), circumferences of both calves and ankles, and a VAS-pain scale were recorded. At 7 and 28 days from baseline, patients were re-assessed by Duplex scanning, calves and ankles circumferences and VAS-pain were measured, and the patients were asked about possible side effects.
  
  
  RESULTS
  At the end of the study period, no propagation to the popliteal vein was observed, and no side effects were reported. Overall, the calf circumference in the affected leg significantly decreased from baseline (38.1 cm) to week 1 (37.1 cm), and to week 4 (35.7 cm). Also the VAS-pain scores significantly decreased during the study - the observed means were 58.4, 30.7, and 12.7 at the three visits, respectively. The percentage of partial recanalization of tibial DVT at 7 days was lower than gastrocnemius DVT (31.6% vs. 59.8%) whereas the percentage of total recanalization at 28 days was comparable (52.6% vs. 59.8%). Complete recanalization occurred in 56.4% of all patients.
  
  
  CONCLUSIONS
  Our study suggests that anticoagulant treatment, associated with compression therapy, is safe and causes clinical improvement (as assessed by calf measurements) and pain relief. Overall complete resolution (56.4%) is significantly higher than in untreated patients (20%). Such results, together with the already reported higher satisfaction of patients for the once-daily administration regimen, should be considered as a viable option for the treatment of DDVT.
authors.affiliation: IDI-IRCCS, Rome, Italy - g.guarnera@idi.it.
authors.forename: G
authors.initials: G
authors.lastname: Guarnera
authors.forename: D
authors.initials: D
authors.lastname: Abeni
authors.forename: P L
authors.initials: PL
authors.lastname: Antignani
authors.forename: A
authors.initials: A
authors.lastname: Apollonio
authors.forename: F
authors.initials: F
authors.lastname: Conti
authors.forename: P L
authors.initials: PL
authors.lastname: Mollo
authors.forename: A
authors.initials: A
authors.lastname: Murgiano
authors.forename: F
authors.initials: F
authors.lastname: Ofria
authors.forename: M
authors.initials: M
authors.lastname: Ruggeri
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D058128:Compression Bandages; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage / Q000009:adverse effects; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D020246:Venous Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy
chemical_list: D000925:Anticoagulants; D017762:Nadroparin