Compression Sonography in the Diagnosis of Deep Venous Thrombosis of the Leg

Aronen, Hannu J.; E, Svedström; Yrjänä, J; Bondestam, S.

doi:10.3109/07853899409148354

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Compression sonography has been used in diagnosing symptomatic thrombosis. This technique is highly sensitive and specific for proximal DVT [14]. Furthermore, technical advances in the development of high resolution equipment, addition of color Doppler and improved individual experience of ultrasonography have lead to greater accuracy in the diagnosis of symptomatic distal DVT [15,16].…”

Section: Discussionmentioning

confidence: 99%

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

Lapidus

Bri

Ponzer

et al. 2006

Journal of Thrombosis and Haemostasis

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To cite this article: Lapidus L, de Bri E, Ponzer S, Elvin A, Noré n A, Rosfors S. High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery. J Thromb Haemost 2006; 4: 807-12.Summary. Background: Phlebography is regarded as the reference standard for diagnosing asymptomatic deep vein thrombosis (DVT) in studies of thromboprophylaxis. However, technical advances with noninvasive color duplex sonography (CDS) have made this procedure an interesting alternative. Objectives: The objective of the present prospective study was to compare the sensitivity and specificity of CDS with those of phlebography. Patients: The first 180 consecutive patients included in a larger randomized trial for prolonged thromboprophylaxis were subject to unilateral CDS and to phlebography after ankle fracture surgery. The patients were examined 6 weeks after surgery, all examinations being evaluated blindly. After patient drop outs and exclusions, 144 patients were left for analysis. Results: Phlebography and CDS examinations were inconclusive or were not completed for 19% of these patients (28/144). DVT was diagnosed by phlebography in 21% (24/ 116) of the remaining patients. Most of the thrombi were isolated calf DVTs (18/24). In contrast, DVT was diagnosed by CDS in 31% of these patients (36/116): only one case diagnosed by phlebography was missed by CDS. The specificity of CDS is thus 86% and its sensitivity is 96%. The positive predictive value is 64%, and the negative predictive value is 99%. Conclusions: CDS is a safe method for detecting asymptomatic distal DVT. It has a high sensitivity and high negative predictive value, which means that the method is highly reliable to rule out DVT. Our results indicate that CDS could be considered as an alternative method for DVT screening.

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Section: Discussionmentioning

confidence: 99%

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

Lapidus

Bri

Ponzer

et al. 2006

Journal of Thrombosis and Haemostasis

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“…Only five other studies have reported on the use of ultrasound for the diagnosis of deep-vein thrombosis specifically in hospitalized patients (2-6). Four studies assessed the accuracy of ultrasonography by per- Table 2 Baseline characteristics of study patients with and without venous thromboembolism Table 3 Prevalence of venous thromboembolism (VTE), initially and on follow-up, according to pretest probability derived by the clinical model * includes DVT day 8 ** includes PE day 20 forming venography in all patients (2,3,5,6). The accuracy was similar to that reported in outpatients with the sensitivity for proximal deep vein thrombosis ranging from 89% to 97% and specificity 86% to 97%.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound is relatively insensitive to deepvein thrombosis isolated to the calf (1) but a serial testing strategy, based on the premise that clinically significant calf vein thrombi will extend by one week and may then be detected, has proven safe in outpatients. Although dozens of studies have evaluated the accuracy and the utility of ultrasound for outpatients with suspected deep vein thrombosis, only five studies have focussed exclusively on inpatients (2)(3)(4)(5)(6). These studies suggested that ultrasound may be less accurate and less safe as a diagnostic test in hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

Application of a Diagnostic Clinical Model for the Management of Hospitalized Patients with Suspected Deep-vein Thrombosis

Wells

Anderson²,

Bormanis³

et al. 1999

Thromb Haemost

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SummaryThe purpose of this study was to evaluate whether the determination of pretest probability using a simple clinical model and the SimpliRED D-dimer could be used to improve the management of hospitalized patients with suspected deep-vein thrombosis. Consecutive hospitalized patients with suspected deep-vein thrombosis, had their pretest probability determined using a clinical model and had a SimpliRED D-dimer assay. Patients at low pretest probability underwent a single ultrasound test. A negative ultrasound excluded the diagnosis of deep-vein thrombosis whereas a positive ultrasound was confirmed by venography. Patients at moderate pretest probability with a positive ultrasound were treated for deep-vein thrombosis whereas patients with an initial negative ultrasound underwent a single follow-up ultrasound one week later. Patients at high pretest probability with a positive ultrasound were treated whereas those with negative ultrasound underwent venography. All patients were followed for three months for the development of venous thromboembolic complications. Overall, 28% (42/150), and 10% (5/50), 21% (14/71) and 76% (22/29) of the low, moderate and high pretest probability patients, respectively, had deep vein thrombosis. Two of 111 (1.8%; 95% CI = 0.02% to 6.4%) patients considered to have deep vein thrombosis excluded had events during three-month follow-up. Overall 13 of 150 (8.7%) required venography and serial testing was limited to 58 of 150 (38.7%) patients. The negative predictive value of the SimpliRED D-dimer in patients with low pretest probability was 96.2%, which is not statistically different from the negative predictive value of a negative ultrasound result in low pretest probability patients (97.8%). Management of hospitalized patients with suspected deep-vein thrombosis based on clinical probability and ultrasound of the proximal deep veins is safe and feasible.Dr. Philip Wells and Dr. David Anderson are the recipients of Research Scholarships from the Heart and Stroke Foundation of Canada.

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“…Additionally, we included 9 studies and 5126 patients to inform the effect of performing a test on patient important outcomes for patients suspected of having DVT. The references for the included studies are as follows: proximal compression ultrasound [84][85][86][87][88][89][90][91][92][93][94][95][96] ; wholeleg ultrasound [97][98][99][100][101][102][103] ; serial ultrasound 84,88,[104][105][106][107] ; D-dimer. [106][107][108][109][110][111][112][113][114][115][116][117][118][119] Low PTP/prevalence (£10%)…”

Section: Summary Of Evidencementioning

confidence: 99%

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

et al. 2018

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Background: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. Objective: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. Methods: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. Results: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. Conclusions: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

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Compression Sonography in the Diagnosis of Deep Venous Thrombosis of the Leg

Cited by 12 publications

References 25 publications

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery

Application of a Diagnostic Clinical Model for the Management of Hospitalized Patients with Suspected Deep-vein Thrombosis

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism

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