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The 2016 guidelines from the American College of Chest Physicians (ACCP) on managing venous thromboembolic disease contained several “weak” recommendations, based on low-quality evidence (Chest 2016; 149:315). Recent studies have added evidence that supports two of these recommendations.
As many as half of all deep venous thromboses (DVTs) in the legs are isolated to the calves and probably have limited embolic potential. For isolated calf DVTs in low-risk patients, the 2016 ACCP recommendation was sonographic monitoring without anticoagulation. To determine whether anticoagulation is beneficial in such patients, European investigators randomized 259 low-risk adult outpatients with first symptomatic isolated calf DVTs to daily subcutaneous n…