The Diagnostic Approach to Acute Venous Thromboembolism

Vf, Tapson; Carroll, BA; Bl, Davidson; Cg, Elliott; Pf, Fedullo; Hales, Crispin; Hull, R. D.; Tm, Hyers; Kv, Leeper; Morris, TA; Km, Moser; Ge, Ruigang; Shure, Deborah; Hd, Sostman; B, Taylor Thompson

doi:10.1164/ajrccm.160.3.16030

Cited by 289 publications

(19 citation statements)

References 222 publications

(241 reference statements)

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“…Patients with lower extremity DVT often do not present with erythema, pain, warmth, swelling, or tenderness. Symptomatic patients with proximal DVT may present with lower extremity pain, calf tenderness, and lower extremity swelling 22,23. Homans’ sign may be demonstrable in DVT.…”

Section: Resultsmentioning

confidence: 99%

“…The other advantages of venous ultrasound are its ability to diagnose other pathologies (Baker’s cysts, superficial or intramuscular hematomas, lymphadenopathy, femoral aneurysm, superficial thrombophlebitis, and abscess), and the fact that there is no risk of exposure to irradiation, while its major limitation is its reduced ability to diagnose distal thrombus 22. Venous compressibility may be limited by a patient’s characteristics such as obesity, edema, and tenderness as well as by casts or immobilization devices that limit access to the extremity.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Deep vein thrombosis: a clinical review

Kesieme

Kesieme²,

Jebbin³

et al. 2011

JBM

160

135

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Background:Deep vein thrombosis (DVT) is the formation of blood clots (thrombi) in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein) or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality.Aim:To present an update on the causes and management of DVT.Methods:A review of publications obtained from Medline search, medical libraries, and Google.Results:DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome.Conclusion:DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban and apixaban). Others are currently undergoing trials. Thrombolytics and vena caval filters are very rarely indicated in special circumstances.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Deep vein thrombosis: a clinical review

Kesieme

Kesieme²,

Jebbin³

et al. 2011

JBM

160

135

View full text Add to dashboard Cite

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“…Because calf veins are smaller and characterized by slower flow, the US assessment is more difficult than in the proximal lower extremity veins. Additionally, venous compressibility may be limited by patient characteristics such as obesity, edema and tenderness [11]. …”

Section: Discussionmentioning

confidence: 99%

Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis

et al. 2018

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SummaryBackgroundTo investigate the usefulness of popliteal artery spectral doppler findings as a complimentary approach to isolated calf vein thrombosis (DVT).Material/MethodsWe included consecutive patients presenting with symptomatic and sonographically proven acute isolated calf DVT. Patients with thrombosis of any other vein were excluded. We classified calf vein into into four main types. We investigated how many of these four vessels had DVT and compared them with respect to the pulsatility index (PI) value of the popliteal artery.ResultsWe evaluated spectral doppler characteristics of the popliteal artery on the same side as the isolated calf vein thrombosis as well as on the opposite side. The relationship between PI values of the popliteal artery and the number of thrombosed calf veins was investigated. In patients with 1 and/or 2 thrombosed veins, the mean PI was 6.03±0.54 on the side of cDVT and 5.68±0.39 on the opposite side (p=0.008), respectively. Inpatients with 3 and/or 4 thrombosed veins, the mean PI was 8.05±0.61 on the side of cDVT and 6.34±0.47 on the opposite side (p=0.001), respectively.ConclusionsVenous doppler sonography for the evaluation of calf DVT may be limited by patient characteristics such as obesity, edema, and tenderness., Arterial PI can be used as a complimentary technique for the detection of venous thrombosis in such of cases.

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“…The first aspect drawing attention to the principal etiological factor of PE is usually emphasized: deep venous thrombosis [22]. Nonetheless, it seems clear that early diagnosis and therapy improve the prognosis and natural evolution of PE.…”

Section: Discussionmentioning

confidence: 99%

“…With the results obtained, plasma DD levels have low sensitivity as a discriminant parameter between PE and pneumonia. These data and others [30, 31, 32]make it difficult to recommend the DD test as a standard part of the pulmonary embolism diagnostic algorithm at the present time [22]. …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of D Dimer in Pulmonary Embolism and Pneumonia

Castro

Pérez-Rodríguez²,

Montaner³

et al. 2001

Respiration

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Background: Diagnosis of pulmonary embolism (PE) and its clear-cut differentiation with other entities of occasional similar presentation remains difficult in routine clinical practice. High plasmatic levels of D dimer (DD), a specific fibrin derivate, have recently been reported in PE. Objective: The purpose of this study was to prospectively evaluate the diagnostic value of plasmatic DD in a clinical setting. Methods: We studied 52 patients with PE proven with pulmonary scintigraphic studies in relation to 19 patients posteriorly diagnosed of having community-acquired pneumonia and 30 healthy subjects. Evolution of DD levels whilst the patients were on intravenous anticoagulant therapy was evaluated by measuring DD concentration on admission and on day 7 in 10 patients. Results: Plasma DD levels were significantly higher in PE in relation to controls (p < 0.001). DD levels were also higher in patients diagnosed with community-acquired pneumonia in relation to controls (p < 0.05) but lower than those obtained in high probability PE (p < 0.05). Sensitivity and specificity of plasmatic DD in the emergency diagnosis of PE are of 92 and 71%, respectively. Plasma levels of DD were found to progressively decrease during the first week of heparin therapy, but they remained higher than in control subjects. Conclusions: Plasma DD levels are increased in patients with suspected PE and the degree of elevation is related to the results obtained in scintiscans. Moreover, DD concentrations progressively decrease during the first week of anticoagulant therapy. The increased DD levels found in patients with pneumonia make this test useless in the differential diagnosis between these two clinical entities.

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The Diagnostic Approach to Acute Venous Thromboembolism

Cited by 289 publications

References 222 publications

Deep vein thrombosis: a clinical review

Deep vein thrombosis: a clinical review

Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis

Diagnostic Value of D Dimer in Pulmonary Embolism and Pneumonia

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