Calf vein thrombosis in spinal cord injured patients: conservative management of two cases.

Several studies have suggested that if a calf vein thrombosis does not propagate above the knee when followed up with serial diagnostic studies, full anticoagulation may not be necessary. These studies have not included spinal cord injured patients. Two patients with spinal cord injury were diagnosed with acute calf vein thrombosis after admission to a spinal cord injury rehabilitation unit. Both patients refused intravenous heparinization. Serial duplex Doppler studies were performed on both patients to evaluate for propagation of thrombus. Neither patient developed propagation of thrombus, pulmonary embolus, or persistent thrombophlebitis. Full anticoagulation including intravenous heparinization is costly, subject to complications, and interferes with intensive rehabilitation therapies. Observation of calf vein thrombosis with appropriate serial follow-up studies may be a viable alternative to anticoagulation in spinal cord injured patients. Further studies need to be done with this unique patient population.