The value of clinical signs in the diagnosis of deep venous thrombosis

Nicolaides, Andrew; Meadway, J.; Irving, Doreen

doi:10.1007/978-94-011-6144-2_17

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…The risk and expense of venography are greatly outweighed by the risk and expense of unnecessary anticoagulation. (6) Deep vein thrombosis should not be diagnosed or excluded without objective confirmation either by venography or by a combination of methods that detect proximal and calf thrombosis -for instance, ultrasound plus 125I-fibrinogen uptake. (Accepted 23 December 1982) Is the anthelmintic levamisole of any value in the treatment of recurrent aphthous ulceration of the mouth ?…”

Section: Resultsmentioning

confidence: 99%

Impact of venography on the diagnosis and management of deep vein thrombosis.

Ramsay¹

1983

BMJ

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Section: Resultsmentioning

confidence: 99%

Impact of venography on the diagnosis and management of deep vein thrombosis.

Ramsay¹

1983

BMJ

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“…46 In contrast, in patients with normal venograms, 81% had pain in the legs, 66% had ankle edema, and 52% had palpable differences in temperature; these finding were only slightly more common in those with DVT. 47 In contrast, it has been estimated that 50 to 85% of patients with DVT present without symptoms; in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study only 15% of patients had clinical evidence of DVT. Similarly, in high-risk groups following hip or knee surgery, clinical evidence of DVT has been absent in a majority of patients with positive venograms.…”

Section: Diagnosismentioning

confidence: 99%

Venous Thromboembolism in Pregnancy

Weg¹

1998

Semin Respir Crit Care Med

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Venous thromboembolism (VTE) is the leading nonobstetric cause of mater nal morbidity and mortality. The risk for deep venous thrombosis (DVT) commences in the first trimester with a striking proclivity for the left lower extremity. Pulmonary em bolism (PE) is more frequent in the postpartum period. Activated protein-C resistance in creases the risk of VTE 30-to 50-fold in heterozygotes and several hundred-fold in homozygotes. Other inherited and acquired factors also increase the risk.The diagnosis of DVT and PE is even more difficult in pregnancy because of the com mon occurrence of leg edema, leg pain, and dyspnea. VTE requires objective proof: (1) DVT-positive duplex ultrasound or impedance plethysmography and (2) PE-positive non invasive lower extremity study, a high-probability perfusion lung scan (normal excludes PE), or a pulmonary angiogram. Concern over fetal radiation from these diagnostic stud ies is not warranted. Initial treatment of VTE is the same as in the nonpregnant patient. However, warfarin should not be used. In its place, low-molecular-weight heparin or unfractionated heparin should be given for the duration of pregnancy; warfarin should be given for at least 6 weeks postpartum or for ≥3 months. The indications for VTE prophy laxis are discussed. Key Words: deep venous thrombosis, embolism, pulmonary embolism, heparinMaternal mortality during and immediately fol lowing pregnancy, labor, and delivery is, fortunately, quite rare. Venous thromboembolism (VTE) is a leading cause of illness during pregnancy and the purperium and is the leading cause of nonobstetric maternal mortality. 1-4 Much of the data available on VTE until very recently has been flawed by lack of ob jective studies for diagnosis and the absence of pro spective randomized trials concerning management. PATHOPHYSIOLOGYVTE is approximately five times greater in pregnant than nonpregnant women of similar age. The most constant predisposing factor is increased venous stasis. The physiologic changes of pregnancy result in increased venous distensability and capaci tance, which are evident in the first trimester. 56 In the second and third trimesters the gravid uterus causes additional venous stasis. Obstetrical factors that independently contribute to the risk of VTE are cesarean section, advanced maternal age, pro longed bedrest, hemorrhage, sepsis, multiparity, and obesity. Coagulation factors II, VII, and X in crease appreciably by midpregnancy. Fibrin genera tion increases and protein-S decreases. Protein-C levels are unchanged. The fibrinolytic system is in hibited, particularly in the third trimester. 7-12 PREDISPOSING FACTORS INHERITEDActivated protein-C resistance (APCR) is due, in a majority of patients, to a specific point mutation in the gene for coagulation factor V-Leiden in which adenine is substituted for guanine at nucleotide 1691. Although only identified recently, it has al ready been shown to be the most common inherited risk factor for VTE.

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“…14,15 The development of the noninvasive accurate techniques of impedance plethysmography and real time B-mode compression ultrasonography coupled with the well-documented lack of specificity and sensitivity of clinical findings has changed clinical practice so that the norm for the diagnosis of DVT is one of these studies. [16][17][18][19] In contrast to the relatively recent development of diagnostic tools, heparin was used in treating DVT in 1938 20 and pulmonary embolism in 1946 21 ; its extraordinary effectiveness was reported in a controlled trial in 1960. 22 The efficacy of oral anticoagulants was reported in the early 1940s 23,24 and a controlled trial for prophylaxis in trauma patients in 1959.…”

Section: The Past*mentioning

confidence: 99%

Venous Thromboembolism: Past, Present and Future

Weg

2000

Seminars in Respiratory and Critical Care Medicine

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Over the last four decades there have been remarkable advances in the diagnosis and treatment of venous thromboembolism (VTE)-pulmonary embolism (PE) and deep venous thrombosis (DVT). We have moved from no objective documentation to a plethora of ever improving imaging studies. Evolving treatment modalities have reduced the mortality due to PE to approximately 2%. Shorter hospitalizations followed by outpatient therapy are a growing reality. The use of primary prophylaxis is increasing, but more widespread use must be encouraged. Despite the many accomplishments, too many patients with VTE with its high mortality without treatment remain undiagnosed. There is a critical need to improve the role of the patient's history in identifying patients who warrant objective testing. The ideal would be the development of a biological marker of VTE, similar to the creatinine kinase-MB, creatinine kinase-MM, or troponin I in acute myocardial infarction.

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The value of clinical signs in the diagnosis of deep venous thrombosis

Cited by 6 publications

References 8 publications

Impact of venography on the diagnosis and management of deep vein thrombosis.

Impact of venography on the diagnosis and management of deep vein thrombosis.

Venous Thromboembolism in Pregnancy

Venous Thromboembolism: Past, Present and Future

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