Duplex Venous Scanning for the Prospective Surveillance of Perioperative Venous Thrombosis

Flinn, William R.; Sandager, Gail P.; Cerullo, Leonard J.; Havey, Robert J.; Yao, James S.T.

doi:10.1001/archsurg.1989.01410080031004

Cited by 60 publications

(10 citation statements)

References 19 publications

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“…Thirteen randomized clinical trials [48][49][50][51][52][53][54][55][56][57][58][59][60] and 5 cohort studies [61][62][63][64][65] met our inclusion criteria ( Table 5 and Table 6). Several others failed to meet our inclusion criteria.…”

Section: Neurosurgical Patientsmentioning

confidence: 99%

Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

Attia¹,

Ray²,

Cook³

et al. 2001

Arch Intern Med

322

165

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Section: Neurosurgical Patientsmentioning

confidence: 99%

Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

Attia¹,

Ray²,

Cook³

et al. 2001

Arch Intern Med

322

165

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“…19 It is uncertain whether there is a role for ultrasonographic surveillance of high-risk surgical patients who cannot receive primary prophylaxis. 36,37…”

Section: Venous Ultrasound Imagingmentioning

confidence: 99%

Noninvasive Diagnosis of Deep Vein Thrombosis in Postoperative Patients

Kearon¹

2001

Semin Thromb Hemost

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The accuracy of noninvasive testing for the diagnosis of deep vein thrombosis (DVT) generally is less in asymptomatic patients than it is in those with symptoms suggestive of thrombosis. This is because asymptomatic DVT often is confined to the distal veins and, when it involves the proximal veins, the thrombi usually are smaller than in symptomatic patients with proximal thrombosis. Because the positive predictive value of noninvasive tests for asymptomatic DVT generally is 80% or less, abnormal results should be confirmed by venography. There are two main reasons why asymptomatic DVT is sought in the postoperative period: (1) to identify the need for full-dose anticoagulant therapy to prevent symptomatic episodes of venous thromboembolism (VTE), including fatal pulmonary embolism (this represents a form of secondary prophylaxis), and (2) to use this outcome as a surrogate for episodes of clinically important VTE in studies that are designed to evaluate methods of venous thrombosis prophylaxis. In relation to the first of these indications, evidence suggests that routine surveillance of high-risk patients to detect asymptomatic postoperative DVT does not result in improved clinical outcomes in patients who received appropriate VTE prophylaxis. In relation to the second indication, there is concern that asymptomatic VTE may not be a reliable surrogate for clinically important VTE, particularly if the effectiveness of different antithrombotic agents is being compared. Coupled with the comparatively low accuracy of noninvasive testing for asymptomatic DVT, this suggests that the results of such testing are unsuitable for the evaluation of new methods of prophylaxis in clinical trials.

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“…2,15,23 While this modality is not as sensitive for diagnosing DVT as the gold standard of lower-extremity venography, 14 it has certainly helped in earlier and increased detection of DVTs. 8,11,19 What remains unclear is when and how often these ultrasound studies should be performed to maximize DVT screening and detection, as well as possibly improve In the present study, over a period of 1 year, we investigated, in an acute inpatient setting, the usefulness of routine screening ultrasonography in all neurosurgical patients and determined whether there are any differences between the various subsets of the population. To ascertain if there is an optimal time window for DVT screening, we also analyzed the frequency and duration of ultrasound surveillance.…”

mentioning

confidence: 99%

An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography

Patel¹,

Koltz²,

Sansur³

et al. 2013

JNS

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Object. Patients requiring neurosurgical intervention are known to be at increased risk for deep vein thrombosis (DVT) and attendant morbidity and mortality. Pulmonary embolism (PE) is the most catastrophic sequela of DVT and is the direct cause of death in 16% of all in-hospital mortalities. Protocols for DVT screening and early detection, as well as treatment paradigms to prevent PE in the acute postoperative period, are needed in neurosurgery. The authors analyzed the effectiveness of weekly lower-extremity venous duplex ultrasonography (LEVDU) in patients requiring surgical intervention for cranial or spinal pathology for detection of DVT and prevention of PE.Methods. Data obtained in 1277 consecutive patients admitted to a major tertiary care center requiring neurosurgical intervention were retrospectively reviewed. All patients underwent admission (within 1 week of neurosurgical intervention) LEVDU as well as weekly LEVDU surveillance if the initial study was normal. Additional LEVDU was ordered in any patient in whom DVT was suspected on daily clinical physical examination or in patients in whom chest CT angiography confirmed a pulmonary embolus. An electronic database was created and statistical analyses performed.Results. The overall incidence of acute DVT was 2.8% (36 patients). Of these cases of DVT, a statistically significant greater number (86%) were discovered on admission (within 1-7 days after admission) screening LEVDU (p < 0.05), whereas fewer were documented 8-14 days after admission (2.8%) or after 14 days (11.2%) postadmission. Additionally, for acute DVT detection in the present population, there were no underlying statistically significant risk factors regarding baseline physical examination, age, ambulatory status, or type of surgery.The overall incidence of acute symptomatic PE was 0.3% and the mortality rate was 0%. Conclusions. Performed within 1 week of admission in patients who will undergo neurosurgical intervention, LEVDU is effective in screening for acute DVT and initiating treatment to prevent PE, thereby decreasing the overall mortality rate. Routine LEVDU beyond this time point may not be needed to detect DVT and prevent PE unless a change in the patient's physical examination status is detected. (http://thejns.org/doi/abs/10.3171/2012.11.JNS121243) key WorDs • deep vein thrombosis • ultrasonography • pulmonary embolism 505Abbreviations used in this paper: DVT = deep vein thrombosis; IVC = inferior vena cava; PE = pulmonary embolism.

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Duplex Venous Scanning for the Prospective Surveillance of Perioperative Venous Thrombosis

Cited by 60 publications

References 19 publications

Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

Noninvasive Diagnosis of Deep Vein Thrombosis in Postoperative Patients

An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography

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