ACP InternistMKSAP Quiz: Evaluation for Right Calf Pain

After 24 hours, a 24-year-old woman’s right calf soreness has been evaluated. She says she doesn’t have chest pain, a cough, or shortness of breath. Her medical background is not noteworthy. What is the best course of action after a physical examination and an ultrasound?

In this clinical scenario, a 24-year-old woman presents with right calf pain and is found to have an acute thrombosis of the right lesser saphenous vein measuring 7 cm in length. Physicians are prompted to identify the most appropriate management approach. Here are the proposed strategies:

• Initiate anticoagulation therapy for a duration of 3 months. This is typically recommended for conditions provoked by reversible risk factors.
• Administer anticoagulation therapy lasting for 6 weeks. This is often used when the size or location of the thrombus, or presence of certain risk factors, necessitates more than a short-term intervention.
• Perform vein ligation. This option may be considered for those with a higher risk profile or absolute contraindication to anticoagulation, although it is not generally part of routine care.
• Adopt observation complemented with ultrasound surveillance. This conservative strategy might be suitable when the thrombus does not present high-risk features. If symptoms persist or the thrombus extends, a more aggressive intervention might be warranted.

Given the circumstances, what would be the most appropriate course of management?

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Did You Know?
Superficial vein thrombosis (SVT), often thought to be a benign condition, is actually associated with a significant risk of deep vein thrombosis and pulmonary embolism, similar to the risks associated with a deep vein thrombosis.