Deep vein thrombosis screening: Difference between revisions

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| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br>
| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}  [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]; {{Rim}}
{{Deep vein thrombosis}}
{{Deep vein thrombosis}}
==Overview:Value of screening==
In-spite of identifying patients at increased risk of VTE, there is no clear clinical value for screening, the following reason explains
*The strongest risk factor for VTE recurrence is the prior VTE event itself.
*After discontinuation of warfarin in VTE patients, especially where the cause was unknown, there are still at high risk of recurrence. irrespective of the presence of inherited thrombophilia.
*Anticoagulant prophylaxis is rarely recommended in asymptomatic affected family members outside of high risk situations.


==Who should be screened?==
==Overview==
Patients having any of the following, should be screened for inherited [[Thrombophilia]]
In spite of identifying patients at increased risk of [[venous thromboembolism]] (VTE), there is no clear clinical value for screening the general population. Screening for asymptomatic deep vein thrombosis (DVT) with venous [[compression ultrasound]] is not recommended for critically ill medical patients,<ref name="pmid22315261">{{cite journal| author=Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA et al.| title=Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e195S-226S | pmid=22315261 | doi=10.1378/chest.11-2296 | pmc=PMC3278052 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315261  }} </ref> patients undergoing general surgery<ref name="pmid22315263">{{cite journal| author=Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA et al.| title=Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e227S-77S | pmid=22315263 | doi=10.1378/chest.11-2297 | pmc=PMC3278061 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315263  }} </ref> or orthopedic surgeries.<ref name="pmid22315265">{{cite journal| author=Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al.| title=Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e278S-325S | pmid=22315265 | doi=10.1378/chest.11-2404 | pmc=PMC3278063 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315265  }} </ref>
*Initial thrombosis occurring at age<50, without an immediately identified risk factor
*Positive family history of thromboembolism at age<50
*Recurrent venous thrombosis
*Thrombosis occurring in unusual vascular beds such as portal, hepatic, mesenteric, or cerebral veins
*History of [[warfarin]]-induced skin necrosis.
 
==Who should not screened?==
* Active malignancy
* Recent major surgery or immobilization
* Systemic lupus erythematosus
* Inflammatory bowel disease
* Myeloproliferative disorders
* Preeclampsia at term
* Retinal vein thrombosis
* Upper limb venous thrombosis
 
===Probability scoring===
In 2006, Scarvelis and Wells overviewed a set of [[clinical prediction rule]]s for DVT,<ref>{{cite journal | author = Scarvelis D, Wells P | title = Diagnosis and treatment of deep-vein thrombosis. | journal = CMAJ | volume = 175 | issue = 9 | pages = 1087-92 | year = 2006 | id = PMID 17060659. [http://www.cmaj.ca/cgi/content/full/175/9/1087 Free Full Text] }}</ref> on the heels of a widely adopted set of clinical criteria for pulmonary embolism.<ref>Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. ''American Family Physician''. 2003; '''68'''(4):759-?.  Available at: [http://www.aafp.org/afp/20030815/practice.html http://www.aafp.org/afp/20030815/practice.html]. Accessed on: December 8, 2006.</ref><ref>{{cite journal | author = Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J | title = Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. | journal = Thromb Haemost | volume = 83 | issue = 3 | pages = 416-20 | year = 2000 | id = PMID 10744147}}</ref>
 
===Wells score or criteria===
(Possible score -2 to 9)
 
:1) Active cancer (treatment within last 6 months or palliative) -- 1 point
:2) Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point
:3) Collateral superficial veins (non-varicose) -- 1 point
:4) Pitting edema (confined to symptomatic leg) -- 1 point
:5) Swelling of entire leg - 1 point
:6) Localized pain along distribution of deep venous system -- 1 point
:7) Paralysis, paresis, or recent cast immobilization of lower extremities -- 1 point
:8) Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks -- 1 point
:9) Previously documented DVT -- 1 point
:10) Alternative diagnosis at least as likely -- Subtract 2 points
 
===Interpretation===
: Score of 2 or higher - deep vein thrombosis is likely. Consider imaging the leg veins.
: Score of less than 2 - deep vein thrombosis is unlikely. Consider blood test such as [[d-dimer]] test to further rule out deep vein thrombosis.
 
Cases have been reported when the well score was zero <ref name="pmid21476378">{{cite journal| author=Pai RP, Kangath RV, Brown TA| title=Saddle pulmonary thromboembolism with zero Wells' score. | journal=Conn Med | year= 2011 | volume= 75 | issue= 2 | pages= 89-91 | pmid=21476378 | doi= | pmc= | url= }} </ref>.


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Hematology]]
[[Category:Angiology]]
[[Category:Emergency medicine]]
[[Category:Vascular surgery]]
[[Category:Up-To-Date]]
[[Category:Cardiovascular diseases]]
{{WH}}
{{WS}}

Latest revision as of 11:58, 13 July 2014
Resident
Survival
Guide

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet; Rim Halaby, M.D. [3]

Deep Vein Thrombosis Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Deep vein thrombosis from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

Assessment of Clinical Probability and Risk Scores

Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Ultrasound

Venography

CT

MRI

Other Imaging Findings

Treatment

Treatment Approach

Medical Therapy

IVC Filter

Invasive Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT

Recurrence

Pregnancy

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis screening On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis screening

CDC on Deep vein thrombosis screening

Deep vein thrombosis screening in the news

Blogs on Deep vein thrombosis screening

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis screening

Overview

In spite of identifying patients at increased risk of venous thromboembolism (VTE), there is no clear clinical value for screening the general population. Screening for asymptomatic deep vein thrombosis (DVT) with venous compression ultrasound is not recommended for critically ill medical patients,[1] patients undergoing general surgery[2] or orthopedic surgeries.[3]

References

  1. ↑ Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA; et al. (2012). "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e195S–226S. doi:10.1378/chest.11-2296. PMC 3278052. PMID 22315261.
  2. ↑ Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA; et al. (2012). "Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e227S–77S. doi:10.1378/chest.11-2297. PMC 3278061. PMID 22315263.
  3. ↑ Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S; et al. (2012). "Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e278S–325S. doi:10.1378/chest.11-2404. PMC 3278063. PMID 22315265.

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