Noninvasive Objective Tests for the Diagnosis of Clinically Suspected Deep-Vein Thrombosis

Cogo, Alberto; Lensing, Anthonie W. A.; Wells, Phil; Prandoni, Paolo; Büller, Harry R.

doi:10.1159/000217141

Cited by 36 publications

(38 citation statements)

References 26 publications

(33 reference statements)

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“…First, both inpatients and individuals on oral anticoagulant treatment (OAT) were considered ineligible, given the lower diagnostic value of DD in those subsets of patients [13]; patients on warfarin made up 46% of subjects enrolled in the study mentioned above, but a high rate of false negative DD results in this setting has been reported [12]. Second, clinical evaluation was not part of the diagnostic approach and DVT exclusion was solely based on a negative DD result; even though, only a minority of patients likely to have DVT show normal DD concentrations, and clinical assessment may help not to miss potential DVT cases with a normal DD result in this probability group that would be overlooked should only DD be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Lower-limb Doppler CVU was performed within three hours of admission to the Emergency Department by a Senior Radiologist who was aware of any previous ultrasonographic investigations, if available; compression was performed at standard 1-cm intervals all along the longitudinal axis of the venous system of the leg (common femoral vein, superficial femoral vein, and popliteal vein) up to the popliteal trifurcation [11,12]. Acute recurrent DVT was diagnosed if evidence of noncompressibility in a venous segment previously known to be free of disease or an increase in compressed venous diameter greater than 4 mm from baseline study were elicited [3].…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

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Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. 82:41-44, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnostic Proceduresmentioning

confidence: 99%

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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“…Although the D-dimer assay has a high negative predictive value (96-100%), which allows exclusion of VTE [3][4][5], its specificity is only 36-44% [15,16]. On the other hand, lower extremity venous ultrasonography has high sensitivity (93-96%) as well as high specificity (98-99%) for the diagnosis of DVT [6][7][8]. However, ultrasonography in all preoperative patients as a screening tool is considered to represent overuse of this diagnostic resource [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…It remains unclear whether there was no case of DVT in D-dimer-negative patients. However, its reliability can be considered to be acceptable, taking into account the high sensitivity and high negative predictive value of the D-dimer assay and the high sensitivity and high specificity of ultrasonography, which have already been reported [3][4][5][6][7][8]. Moreover, even in D-dimer-positive cases, only 7.4% of patients had DVT.…”

Section: Discussionmentioning

confidence: 99%

“…The D-dimer assay is a safe and useful tool with a high sensitivity (97-100%) for excluding DVT and a high negative predictive value (96-100%) [3][4][5]. Lower extremity venous ultrasonography is the standard method for the diagnosis of DVT, with a high sensitivity (93-96%) and high specificity (98-99%) [6][7][8]. In July 2012, we started preoperative DVT screening at our institution using a combination of D-dimer measurements and lower extremity venous ultrasonography in patients undergoing gastric cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery

et al. 2017

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Background Pulmonary thromboembolism (PE) is one of the life-threatening complications of gastric cancer surgery. D-dimer assay is a safe and rapid tool to exclude the presence of deep venous thrombosis (DVT). In July 2012, we started preoperative DVT screening of patients scheduled for gastric cancer surgery using a combination of D-dimer measurements and lower extremity venous ultrasonography to prevent PE. Methods Between July 2012 and August 2015, 976 consecutive patients underwent gastric cancer surgery with preoperative D-dimer screening. Lower extremity venous ultrasonography was performed in patients with a positive D-dimer assay result (greater than 1.0 lg/ml). The incidence of and risk factors for preoperative DVT and the incidence of PE were examined in patients undergoing gastric cancer surgery. Results Of the 976 patients, 176 (18.0%) showed positive D-dimer assay results, and in 13 (1.3%) DVT was diagnosed by lower extremity ultrasonography. Our analysis identified neoadjuvant chemotherapy as a risk factor for preoperative detection of DVT in patients undergoing gastric cancer surgery (P = 0.021). The incidence of PE was 0.1% (1/976). Conclusion Preoperative gastric cancer patients receiving neoadjuvant chemotherapy seem to be at higher risk for the development of DVT.

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Clinical analysis of preoperative deep vein thrombosis risk factors in patients with colorectal cancer: Retrospective observational study

Nakagawa

Watanabe

Suwa

et al. 2019

Annals of Gastroent Surgery

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Aim Deep vein thrombosis ( DVT ) is a major complication of cancer. The postoperative prevalence of DVT in colorectal cancer ( CRC ) surgery is high, but the preoperative prevalence and the risk factors have not been clarified in detail. The objective of this retrospective study was to investigate the preoperative prevalence and risk factors of DVT in patients admitted to hospital for CRC surgery. Methods From January 2013 to March 2017, 1006 patients admitted for CRC surgery were deemed eligible for this retrospective study. Diagnosis of preoperative DVT was confirmed by compression ultrasonography. Prevalence of silent DVT in lower limbs in patients before CRC surgery was assessed, and the risk factors for preoperative DVT were investigated regarding the correlation of DVT with the patient's background. Results Preoperative DVT and asymptomatic pulmonary thromboembolism were diagnosed in 136 (13.5%) and in 10 (1.0%) of 1006 patients overall, respectively. Multivariate analysis showed that increased age (≥75 years), female gender, and an elevated d ‐dimer level (>1.0 μg/mL) were independent risk factors for preoperative DVT in this study. Notably, the prevalence of preoperative DVT exceeded 50% in patients with all three predictors. Conclusions A high prevalence (13.5%) of preoperative DVT was found in patients admitted to the hospital for CRC surgery. The present results suggest that instrumental screening should be encouraged, at least in subgroups at a higher risk of preoperative DVT .

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Noninvasive Objective Tests for the Diagnosis of Clinically Suspected Deep-Vein Thrombosis

Cited by 36 publications

References 26 publications

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery

Clinical analysis of preoperative deep vein thrombosis risk factors in patients with colorectal cancer: Retrospective observational study

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