Diagnosis of deep vein thrombosis, an overview

Janssen, Mirian C. H.; Wollersheim, Hub; Nováková, I.R.O.; Heystraten, F.M.J.; Asten, W.N.J.C. van; Thien, Th.

doi:10.1016/0300-2977(95)00059-3

Cited by 12 publications

(13 citation statements)

References 120 publications

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“…With the aid of non‐invasive investigations such as VDUS the diagnosis can be made with more certainty and with no patient morbidity. Multiple studies have shown that VDUS has a high sensitivity and specificity in diagnosing both axial and calf DVT 1−9 . A downside is that VDUS is being increasingly ordered to rule out DVT in patients whose pretest probability of DVT is low.…”

Section: Discussionmentioning

confidence: 99%

“…Venous duplex ultrasound scanning (VDUS) is generally recognized as the initial diagnostic test of choice for suspected deep venous thrombosis (DVT), with a high sensitivity and specificity in detecting both axial and calf vein thrombi 1−9 . It was a protocol recommendation of the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) that both legs be scanned even for unilateral symptoms of DVT 10 .…”

Section: Introductionmentioning

confidence: 99%

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Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?

Lemech

Sandroussi

Makeham

et al. 2004

ANZ Journal of Surgery

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Overall the diagnostic yield of VDUS was low in this study, with an incidence of 16% of DVT detected in symptomatic patients. Techniques that improve the diagnostic yield of VDUS in symptomatic patients are required. A significant proportion (23%) of the DVT detected in this study were bilateral, and a small but significant proportion (10%) of DVT found in patients presenting with unilateral symptoms were only in the asymptomatic contralateral limb. Our study supports bilateral VDUS in symptomatic inpatients, as the detection of DVT in asymptomatic limbs aids future patient management if symptoms develop in the asymptomatic limb.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?

Lemech

Sandroussi

Makeham

et al. 2004

ANZ Journal of Surgery

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“…Es sprechen drei Gru Ènde gegen den Einsatz des 125-Iod-Fibrinogen-Testes als Screeningverfahren: Die Belastung des Patienten mit radioaktiven Substanzen, das nicht vo Èllig auszuschlieûende Infektionsrisiko und die mangelnde Korrelation mit klinisch signifikanten Thrombosen [17]. Florda et al stellten 1995 bei 2 578 Patienten fest, daû sich nur bei 14 % der positiven nuklearmedizinischen Ergebnisse tatsa Èchlich phlebographisch eine Thrombose besta Ètigte [13].…”

Section: Farbcodierte Duplexsonographie Als Untersuchungsmethodeunclassified

“…Die Phlebographie gilt zur Zeit nach wie vor als der Goldstandard zur Diagnose veno Èser Thrombosen. Neben der unvermeidlichen Strahlenbelastung stellten Kontrastmittelunvertra Èglichkeiten bislang das Hauptrisiko der Untersuchung dar, welches jedoch durch den Einsatz niederosmolarer Kontrastmittel deutlich verringert wurde [17,29,30]. Dennoch ist diese Untersuchung fu Èr ein reines Screeningverfahren aufgrund des Restrisikos und der subjektiven Belastung fu Èr den Patienten letztendlich schwer vertretbar.…”

Section: Farbcodierte Duplexsonographie Als Untersuchungsmethodeunclassified

Prospektiv randomisierte Studie zum Vergleich der Wirksamkeit und der Verträglichkeit verschiedener niedermolekularer Heparine bei Hochrisikopatienten

Bergauer¹,

Rjosk²,

Lohscheidt³

et al. 2001

Zentralbl Chir

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“…Whereas a constant filling defect is usually considered to represent acute venous thrombosis, the other findings may also result from old thrombi or artifacts. Janssen et al(10) interviewed 50 patients about side effects. Of these, 20% experienced unpleasant side effects.…”

mentioning

confidence: 99%

Exclusion and Diagnosis of Deep Vein Thrombosis by a Rapid ELISA D-dimer Test, Compression Ultrasonography, and a Simple Clinical Model

Michiels¹,

Oortwijn

Naaborg

1999

Clin Appl Thromb Hemost

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The classical clinical signs of deep vein thrombosis (DVT) are unspecific and may be found in several other conditions besides DVT. Therefore, patients suspicious of DVT are subjected to elaborate invasive or noninvasive evidence-based procedures that actually confirm DVT in only 20% to 30% of patients in this setting. However, simple laboratory tests and noninvasive strategies to exclude and diagnose DVT are becoming available in the clinical emergency setting of outpatients. In the presented literature, a sound basis is provided for quantifying clinical judgment for the diagnosis of acute proximal DVT. The number of positive clinical findings at time of first suspicion of DVT appears to correlate directly with the probability of acute proximal DVT. The modified clinical model of Landefeld and Wells for DVT allows reasonable accurate classification of patients into low, moderate, and high probability for suffering DVT. The rapid automated enzyme-linked immunoabsorbant assay (ELISA) VIDAS D-dimer presently available can be rapidly performed in daily practice and emergency situations and is accurate to a high degree, especially in ruling out ongoing venous thromboembolic processes. The sequential use of the rapid ELISA VIDAS D-dimer test and compression ultrasonography in a well-designed clinical setting using a simple clinical model predicts a significant improvement due to a high sensitivity near 100% for the exclusion and diagnosis of DVT in the majority of outpatients with suspect DVT. A prospective decision analysis management study is proposed to exclude and diagnose DVT based on the rapid ELISA VIDAS D-dimer test and compression ultrasonography within the context of a ready-to-use simple clinical model. The proposed simple model of a rational diagnosis of deep vein thrombosis (RADIA DVT) has to be tested in a large multicenter study of more than 1,000 outpatients with suspected DVT. This model would be less expensive, easy to perform, and likely yield a significant simplification and improvement of highly accurate evidence-based exclusion or diagnosis of DVT on the basis of which clear-cut indications of anticoagulation could be appropriately initiated or safely withheld.

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Diagnosis of deep vein thrombosis, an overview

Cited by 12 publications

References 120 publications

Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?

Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?

Prospektiv randomisierte Studie zum Vergleich der Wirksamkeit und der Verträglichkeit verschiedener niedermolekularer Heparine bei Hochrisikopatienten

Exclusion and Diagnosis of Deep Vein Thrombosis by a Rapid ELISA D-dimer Test, Compression Ultrasonography, and a Simple Clinical Model

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