Evaluation of a 40 day (6 week) Low-Molecular-Weight-Heparin treatment (LMWH) for isolated distal deep vein thrombosis of lower limbs at St Luc University hospital, Brussels, Belgium

Details

Supervisors

Hermans, Cédric

Degree label

Master [180] en médecine

Abstract

BACKGROUND: Distal deep vein thrombosis (DVT) includes thrombosis of infra-popliteal veins, namely the peroneal, posterior tibial and anterior tibial veins (axial) as well as muscular veins including the soleus and gastrocnemius. Clinical significance of distal DVT is important because it can potentially resuit in proximal extension, pulmonary embolism (PE), récurrence and/or post-thrombotic syndrome (PTS). Considérable progress in the diagnosis of deep vein thrombosis has been made during the last two décades. However, even though proximal vein thrombosis guidelines for anticoagulation are established, controversy remains about the necessity and modalities of anticoagulation in ail distal DVT. Optimal management of isolated calf DVT is still under discussion and differs between clinicians who treat systematically minding the potential risks and those who prefer simple surveillance with treatment only in case of proximal extension. Studies evaluating the usefulness, the efficacy of anticoagulation, the risk of complications of a simple surveillance with follow-up hâve been done, but no international guideline has been published for isolated distal DVT. AIM, Materials: The aim of this study was to evaluate the efficacy of a 40-day course of Low Molecular Weight Heparin (LMWH) treatment in a cohort of 119 consecutive patients at ‘Cliniques Universitaires St Luc Hospital (Belgium)’, from 2010 to 2017. Compression Ultrasonography of the lower limb was performed at the end of the treatment to identify the persistence or resolution of the blood clôt. A 3-month follow-up after diagnosis was conducted to estimate the risk of récurrence, proximal extension or propagation, pulmonary embolism, post-thrombotic syndrome and bleeding. Multiple risk factors were analyzed. RESULTS: After the 40 day course of LMWH, 71,4% of the patients showed a blood clôt resolution. Persistence of the clôt was statistically associated with the number of involved veins. Patients with initially more than one affected veins were at 4.051 times higher risk for not resolving the clôt. During the 3-month follow-up, récurrence occurred in 5% of patients and was also associated with the number of initial clotted veins, with a 9.3 times higher risk for patients with more than one affected veins initially. Proximal extension and PTS rates were 1,7% and 3,4% respectively, both of them not statistically related with risk factors. No case of Pulmonary Embolism neither Bleeding was identified after the 40 days LMWH treatment in our sample of 119 patients. CONCLUSION: A 40 day weight-based LMWH treatment for distal DVT seems to be efficient when one single vein is affected initially. For multiple vein distal DVT and to avoid potential récurrence, further studies are necessary to estimate the optimal treatment period. Our results confirm the safety of the treatment, its potential to prevent proximal extension and the occurrence of pulmonary embolism.