title: Management of isolated calf vein thrombosis in cancer patients.
abstract: The treatment of isolated calf vein thrombosis remains widely debated. This study highlights the characteristics of isolated calf vein thrombosis in cancer patients and compares to isolated calf vein thrombosis in patients without history of cancer. Between July 2013 and April 2014, a retrospective chart review of consecutive patients with isolated calf vein thrombosis was performed recording patient risk factors, ultrasound characteristics of the thrombus, treatment modalities, long-term recurrence of venous-thromboembolism, incidence of bleeding, and mortality. Of 131 patients with isolated calf vein thrombosis, 53 (40.1%) had history of cancer. Isolated calf vein thrombosis occurred at an older age in cancer patients (66.7 vs 58.5 years, p = 0.004). The anatomical characteristics of isolated calf vein thrombosis on ultrasound were comparable in both groups. Isolated calf vein thrombosis in cancer patients was less likely to be treated with anticoagulation (60.4% vs 80.8%, p = 0.018). However, a trend towards higher incidence of bleeding after initiation of anticoagulation for isolated calf vein thrombosis in cancer patients (11.3% vs 6.4%, p = 0.351) was noted. Mortality in cancer patients was higher (37.7% vs 9.00%, p < 0.001) but was unrelated to isolated calf vein thrombosis or its treatment. In conclusion, the risks of bleeding seem to exceed the benefits of anticoagulation in approximately 50% of cancer patients with isolated calf vein thrombosis. The management of isolated calf vein thrombosis does not seem to impact the survival of cancer patients.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Brahmandam
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kirstyn
authors.initials: K
authors.lastname: Brownson
authors.affiliation: Department of Epidemiology and Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Skrip
authors.affiliation: Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Parker
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Indes
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Timur
authors.initials: T
authors.lastname: Sarac
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA cassius.chaar@yale.edu.
authors.forename: Cassius Iyad Ochoa
authors.initials: CI
authors.lastname: Chaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000925:Anticoagulants
keywords: Isolated calf vein thrombosis; anticoagulation; bleeding; cancer