Contact Thermography, 99mTc-Plasmin Scintimetry and 99mTc-Plasmin Scintigraphy as Screening Methods for Deep Venous Thrombosis Following Major Hip Surgery

Sw, Christensen; Wille‐Jørgensen, Peer; Kjær, Lasse; Stadeager, C.; Widding, Alice; Vestergaard, Aage; Bjerg-Nielsen, A

doi:10.1055/s-0038-1645999

Cited by 13 publications

(3 citation statements)

References 9 publications

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“…Most of these methods have been developed for use in symptomatic patients and most often evaluated with phlebography as the reference method. Evaluation of these methods for screening purposes in asymptomatic postoperative patients has been sporadic, and the results are conflicting (3,4,6,16,18). Especially in hip surgery, a group of patients often confined to thromboprophylactic studies, there seems to be a general opinion that bilateral phlebography is mandatory in all examined patients at a fixed time after surgery (1).…”

Section: Discussionmentioning

confidence: 99%

Phlebography as the Gold Standard in Thromboprophylactic Studies?

et al. 1992

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In 241 patients with total hip arthroplasty and entering a study on thrombosis prophylaxis, phlebography was adequately performed in 451 legs 7 to 11 days after surgery. The phlebograms were primary evaluated by 4 independent observers, and finally a consensus of the images in which disagreement primarily occurred was obtained. The diagnosis of thrombosis in the 4 primary observations varied between 65% and 83% (mean 70%) and the agreement on a negative diagnosis between 97% and 99% (mean 98%). Taking into account agreement by chance, kappa-values varied from 0.60 to 0.83 when the 6 different pairs of observations were compared. When compar ing the primary evaluations with the final consensus, agreements on positive diagnosis varied between 70% and 90% (mean 80%) and on negative diagnosis between 97% and 99% (mean 98%). Kappavalues varied from 0.68 to 0.90. The factor of uncertainty in evalua tion of phlebography may have to be considered when studies on postsurgical thromboprophylaxis are planned.

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Section: Discussionmentioning

confidence: 99%

Phlebography as the Gold Standard in Thromboprophylactic Studies?

et al. 1992

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“…The diagnostic accuracy is comparable to that of FUT [36,37], and it has the [38]. One group compared the plasmin test with phlebography after total hip replacement and found a very low positive predictive value [39]. The plasmin test has not gained widespread use.…”

Section: Plasmin Testmentioning

confidence: 99%

Diagnosis of deep vein thrombosis

Bergqvist

Bergentz

1990

World j. surg.

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A wide range of clinical symptoms and signs are observed with venous thrombosis. Nonetheless, clinical diagnosis has been found to be unreliable and accurate diagnostic methods must be used before potent therapy such as anticoagulation is instituted, since the complications of treatment themselves can be life-threatening. Phlebography is still the basic reference for evaluation of deep venous disease. While it is felt to be the most accurate, there are still limitations relative to difficulty in separating acute from chronic disease, and in obtaining adequate contrast in certain veins such as calf muscles and in the larger intraabdominal veins. Moreover, it is an uncomfortable invasive test, not without complications of its own. The 125I-fibrinogen uptake test is an excellent test for screening for forming thrombi. The sensitivity of this test is high, particularly in the detection of small calf vein thrombi. The primary drawbacks of this technique are that it is falsely positive in cases where there has been bleeding, inflammation, gross edema, arthritis, or leg ulceration. It is not accurate above mid-thigh because of the high blood flow at the level of the groin and pelvis. Radioactive labeled plasmin which will adhere to the surface of recently formed thrombi can also be used for diagnosis. The limitations are a very short half-life of the radioactive label so that repeated investigation of a patient cannot be performed unless new injections are given. The diagnostic accuracy is comparable to that of radioactive labeled fibrinogen and has the same advantages and disadvantages. Plethysmographic techniques have been used with various modifications.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…All have had their advocates; however, due to their limitations, none of these techniques has ever been accepted clinically as suitable for routine use. Radio-isotope scanning, [8][9][10] whilst accurate within the calf, has reduced sensitivity and specificity in the proximal venous system, 11 probably the most important area clinically in relation to the risk of a thromboembolic event. Thermography, [12][13][14] on the other hand, has difficulty differentiating superficial thrombophlebitis from DVT, leading to false positive scans.…”

Section: Introductionmentioning

confidence: 99%