One-Time Comprehensive Ultrasonography To Diagnose Deep Venous Thrombosis: Is That the Solution?
Authors: Dalia El Kheir, Harry Büller
Journal: Annals of Internal Medicine (2004)

Editorials15 June 2004One-Time Comprehensive Ultrasonography To Diagnose Deep Venous Thrombosis: Is That the Solution?Dalia El Kheir, MD, MSc and Harry Büller, MDDalia El Kheir, MD, MScFrom Academic Medical Centre, 1105 AZ Amsterdam, the Netherlands. and Harry Büller, MDFrom Academic Medical Centre, 1105 AZ Amsterdam, the Netherlands.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-12-200406150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The diagnosis of lower-limb deep venous thrombosis (DVT) still poses a daily challenge to health care professionals. Only about 10% to 25% of patients with clinically suspected DVT have DVT confirmed by objective tests (1). If DVT is left untreated, the resulting mortality rate due to pulmonary embolism may exceed 20% (1), whereas a 6-month course of treatment with anticoagulants reduces the mortality rate to less than 1% but carries a 3% to 4% risk for major bleeding (2). Thus, diagnostic strategies to exclude DVT should be accurate, simple to apply to many patients, and cost-effective (3). The article by ...References1. Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation. 1996;93:2212-45. [PMID: 8925592] CrossrefMedlineGoogle Scholar2. Levine MN, Raskob G, Landefeld S, Hirsh J. Hemorrhagic complications of anticoagulant treatment. Chest. 1995;108:276S-290S. [PMID: 7555182] CrossrefMedlineGoogle Scholar3. Perone N, Bounameaux H, Perrier A. Comparison of four strategies for diagnosing deep vein thrombosis: a cost-effectiveness analysis. Am J Med. 2001;110:33-40. [PMID: 11152863] CrossrefMedlineGoogle Scholar4. Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM. Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis. Ann Intern Med. 2004;140:985-91. LinkGoogle Scholar5. Lensing AW, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, et al . Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342-5. [PMID: 2643771] CrossrefMedlineGoogle Scholar6. Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med. 1998;128:663-77. [PMID: 9537941] LinkGoogle Scholar7. Philbrick JT, Becker DM. Calf deep venous thrombosis. A wolf in sheep's clothing? Arch Intern Med. 1988;148:2131-8. [PMID: 3052345] CrossrefMedlineGoogle Scholar8. Cogo A, Lensing AW, Koopman MM, Piovella F, Siragusa S, Wells PS, et al . Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ. 1998;316:17-20. [PMID: 9451260] CrossrefMedlineGoogle Scholar9. Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al . Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345:1326-30. [PMID: 7752753] CrossrefMedlineGoogle Scholar10. Kraaijenhagen RA, Piovella F, Bernardi E, Verlato F, Beckers EA, Koopman MM, et al . Simplification of the diagnostic management of suspected deep vein thrombosis. Arch Intern Med. 2002;162:907-11. [PMID: 11966342] CrossrefMedlineGoogle Scholar11. Bates SM, Kearon C, Crowther M, Linkins L, O'Donnell M, Douketis J, et al . A diagnostic strategy involving a quantitative latex d-dimer assay reliably excludes deep venous thrombosis. Ann Intern Med. 2003;138:787-94. [PMID: 12755550] LinkGoogle Scholar12. Perrier A, Desmarais S, Miron MJ, de Moerloose P, Lepage R, Slosman D, et al . Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353:190-5. [PMID: 9923874] CrossrefMedlineGoogle Scholar13. Kraaijenhagen RA, Lensing AW, Lijmer JG, Prandoni P, Prins MH, Ginsberg JS, et al . Diagnostic strategies for the management of patients with clinically suspected deep-vein thrombosis. Curr Opin Pulm Med. 1997;3:268-74. [PMID: 9262112] CrossrefMedlineGoogle Scholar14. Elias A, Mallard L, Elias M, Alquier C, Guidolin F, Gauthier B, et al . A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs. Thromb Haemost. 2003;89:221-7. [PMID: 12574799] CrossrefMedlineGoogle Scholar15. Schellong SM, Schwarz T, Halbritter K, Beyer J, Siegert G, Oettler W, et al . Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis. Thromb Haemost. 2003;89:228-34. [PMID: 12574800] CrossrefMedlineGoogle Scholar16. Cogo A, Lensing AW, Prandoni P, Hirsh J. Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. Arch Intern Med. 1993;153:2777-80. [PMID: 8257253] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Dalia El Kheir, MD, MSc; Harry Büller, MDAffiliations: From Academic Medical Centre, 1105 AZ Amsterdam, the Netherlands.Disclosures: None disclosed.Corresponding Author: Dalia El Kheir, MD, MSc, Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.Current Author Addresses: Drs. El Kheir and Büller: Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. 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Stevens, MD and C. Gregory Elliott, MD 15 June 2004Volume 140, Issue 12Page: 1052-1053KeywordsD-dimerDeep vein thrombosisHemorrhageProspective studiesSafetySpecificityUltrasound imagingVascular medicineVeinsVenous thromboembolism ePublished: 15 June 2004 Issue Published: 15 June 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...