Propagation of tibial vein thrombus in patients systemically anticoagulated or receiving antiplatelet therapy

The objective of this study was to evaluate the incidence of infrapopliteal deep vein thrombus propagation in postoperative orthopedic patients. This was a retrospective study of patients undergoing noninvasive venous testing to rule out phlebothrombosis. Venous duplex scans and Doppler studies to r ecord thrombus location were performed at the end of treatment, which laste d from 2 weeks to 1 year (mean: 6 months). The study included 28 postoperat ive orthopedic patients; 21 men and seven women with a mean age of 52 years (range: 14 to 92 years). Patients received three different treatment regim ens. Group I received heparin and warfarin (n = 17; 60.7%); Group II receiv ed warfarin (n = seven; 25%); Group III received aspirin (n = four; 14.3%). Isolated tibial vein thrombosis was found in 10 patients, (36%) and 18 pati ents (64%) exhibited multiple tibial veins involvement. Follow-up venous du plex and Doppler studies revealed a single episode (5.9%) of thrombus propa gation from an isolated tibial vein to multiple tibial veins in Group I. Th ere were four Group II patients with isolated and three with multiple tibia l vein thrombi. Clot propagation occurred in three (42.9%) instances; two o riginated from isolated tibial vein thromboses and all extended into the po pliteal and femoral veins. No propagation occurred in the limbs of Group II I. Statistical analysis of treat-ment protocols revealed a significant diff erence in outcome (clot propagation) based on management. Warfarin therapy alone (Group II) resulted in a significantly increased risk for clot propag ation (p < 0.04), whereas there was no difference in the incidence of clot propagation based on the number of involved tibial veins (p < 0.12). Warfarin treatment alone was not found to be an effective method of prevent ing thrombus propagation in postoperative orthopedic patients with tibial v ein thrombosis. The treatments using heparin/warfarin or aspirin alone were found to be equally effective for preventing this complication.