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Clotting or bleeding? Which is worse? Surgeons grapple with this age-old conundrum every day. When we err on the side of withholding anticoagulants, we face the former, whereas aggressive blood thinning inevitably risks the latter. With the growing body of evidence that calf deep vein thrombosis (DVT) can lead to proximal clot propagation and pulmonary embolism (PE), the same risk-benefit analysis is now being invoked for calf DVT. Some argue that the risks of simply observing a calf DVT are low, but others have linked calf DVT to massive and fatal PE.1,2 Because the existing literature is heterogeneous, the appropriate management of calf DVT remains unclear. This uncertainty is highlighted by the American College of Chest Physicians, which gives its own calf DVT guidelines a grade of 2C (a weak recommendation based on poor evidence).3
Pham XD, de Virgilio C. Significance of Isolated Calf Vein Thrombosis—Further Evidence. JAMA Surg. 2016;151(9):e161799. doi:10.1001/jamasurg.2016.1799