Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study

Abstract

To cite this article: Schellong SM, Beyer J, Kakkar AK, Halbritter K, Eriksson BI, Turpie AGG, Misselwitz F, Kä lebo P. Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost 2007; 5: 1431-7.Summary. Background: Venography is currently used to assess the incidence of deep vein thrombosis (DVT) in dosefinding and confirmatory trials of new antithrombotic agents. Centrally adjudicated, complete compression ultrasound (CCUS) could be a non-invasive alternative to venography. Objectives: A substudy of two, similarly designed, phase IIb trials of a novel, oral anticoagulant for the prevention of venous thromboembolism after elective hip or knee arthroplasty was undertaken to validate CCUS against venography. Patients/Methods: Patients received study drugs until mandatory, bilateral venography was performed 7 ± 2 days after surgery. CCUS was performed within 24 h after venography by sonographers blinded to the venography result. Sonographers were trained and certified for the standardized examination and documentation procedure. Venograms and sonograms were adjudicated centrally at different sites by two independent readers; discrepancies between readers were resolved by consensus. Results: A total of 1104 matching pairs of evaluable venograms and sonograms were obtained from the participants of the two trials (n = 1435): 19% of venograms and 20% of sonograms were not evaluable. The observed frequency of any DVT was 18.9% with venography and 11.5% with CCUS. Sensitivity of CCUS compared with venography was 31.1% for any DVT (95% confidence interval 23.4, 38.9), 21.0% (2.7, 39.4) for proximal DVT, and 30.8% (23.1, 38.6) for distal DVT. The figures for specificity were 93.0% (91.0, 95.1), 98.7% (98.0, 99.5), and 93.3% (91.5, 95.3), respectively. Conclusions: Based on these results, centrally adjudicated CCUS will be unable to replace venography for DVT screening early after major orthopaedic surgery in studies evaluating anticoagulant drugs.

High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study

“…The use of CDS to detect asymptomatic distal DVT, especially directly after trauma or surgery, has been challenged [12,15]. In the present study, CDS was performed 8 weeks after the injury and, as a result, oedema, haematoma and swelling will most probably involve fewer technical problems and the interpretation of the CDS findings might be more unambiguous.…”

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

“…Venous compression ultrasonography (CUS) is the most accurate noninvasive test for DVT diagnosis [12,13]. However, it is established that CUS has reduced sensitivity in patients with minimal symptoms [14,15]. Concern about undiagnosed DVT in the medical-surgical ICU setting is underscored by studies showing that 10% [16,17] to 100% [6] of DVTs identified by screening ultrasound were clinically unsuspected.…”

Acute presentation of deep vein thrombosis in Achilles tendon rupture: A case report

“…The use of colored duplex sonography (CDS) to detect DVT, especially after trauma and surgery has been challenged [7,8]. In a recent study CDS was performed eight weeks after the injury to avoid the technical problems and ambiguity [2].…”