Practical diagnostic management of patients with clinically suspected deep vein thrombosis by clinical probability test, compression ultrasonography, and D-dimer test - 02/09/11
, Evelien Ton, MD a, Theo van Voorthuizen, MD b, Marcel M.C Hovens, MD c, Ivonne Leeuwenburgh, MD c, Sacha Lobatto, MD, PhD b, Pieter J Stijnen, MD, PhD c, Cees van der Heul, MD, PhD d, Peter M Huisman, MD b, Mark H.H Kramer, MD, PhD a, Menno V Huisman, MD, PhD eAbstract |
Purpose |
To evaluate a new noninvasive diagnostic strategy for ruling out deep vein thrombosis consisting of either a combination of low clinical probability and normal ultrasonography or a combination of moderate-to-high clinical probability, normal ultrasonography, and a normal D-dimer test.
Subjects and methods |
We studied 811 patients with clinically suspected deep vein thrombosis using a diagnostic management strategy that combined clinical probability, ultrasonography, and measurement of D-dimers. The primary endpoint was venous thromboembolism occurring during a 3-month follow-up.
Results |
Of the 280 patients (35%) with a low clinical probability, 30 (11%) had an abnormal initial ultrasonography and were treated. Of the other 250 untreated patients with low clinical probability and a normal ultrasonography, 5 (2%; 95% confidence interval [CI]: 1% to 5%) developed a nonfatal venous thromboembolism during follow-up. Of the 531 patients (65%) with a moderate-to-high clinical probability, 300 (56%) had an abnormal ultrasonography. Of the remaining 231 patients with a normal ultrasonography, 148 had a normal D-dimer test; none of these patients developed deep vein thrombosis during follow-up (0%; 95% CI: 0% to 3%). Of the 83 patients with an abnormal D-dimer test, 77 underwent repeat ultrasonography about 1 week later; none of the 64 patients with a second normal ultrasound developed symptomatic deep vein thrombosis during follow-up (0%; 95% CI: 0% to 6%).
Conclusion |
This management strategy, which combines clinical probability, ultrasonography, and D-dimer measurements, is practical and safe in ruling out deep vein thrombosis in patients with clinically suspected thrombosis and reduces the need for repeat ultrasonography.
El texto completo de este artículo está disponible en PDF.Esquema
Vol 113 - N° 8
P. 630-635 - décembre 2002 Regresar al número
Artículo precedente
- Statins do not meet expectations for lowering low-density lipoprotein cholesterol levels when used in clinical practice
- Joseph P Frolkis, Gregory L Pearce, Vijay Nambi, Stephen Minor, Dennis L Sprecher
- Coagulation factors, inflammation markers, and venous thromboembolism: the longitudinal investigation of thromboembolism etiology (LITE)
- Albert W Tsai, Mary Cushman, Wayne D Rosamond, Susan R Heckbert, Russell P Tracy, Nena Aleksic, Aaron R Folsom
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción.
¿Ya suscrito a @@106933@@ revista ?