Correct!
1. Yes
Anticoagulation of soleal thrombosis is controversial and a reasonable argument can be made no anticoagulation. It has been argued that clots below the knee in the superficial veins very rarely result in pulmonary embolism (1). However, the soleus vein is actually a deep vein (Figure 2B). Studfories in the 1990’s and early 2000’s advised anticoagulation but more recent studies have not shown a difference in outcomes (1,2). Current American College of Chest Physicians guidelines recommend no anticoagulation in patients with acute isolated distal deep venous thrombosis (DVT) if the thrombus extends but remains confined to the distal veins (weak recommendation, very low-certainty evidence) (3). However, anticoagulation is recommended if the thrombus extends into the proximal veins (strong recommendation, moderate-certainty evidence). DVT is known to be more common after COVID-19 (4). Clinical judgment including the patient’s own input who favored anticoagulation. She had no contraindications to anticoagulation.
Which anticoagulant should be administered? (Click on the correct answer to be directed to the fifth of six pages)