Deep vein thrombosis screening: Difference between revisions
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{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
==Pre-test probability== | ==Pre-test probability== | ||
In a patient with suspected [[DVT]], establishing pre-test probability helps in early risk stratification and appropriate use of laboratory tests and imaging modalities. | In a patient with suspected [[DVT]], establishing pre-test probability helps in early risk stratification and appropriate use of laboratory tests and imaging modalities. | ||
| Line 62: | Line 53: | ||
A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2. | A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2. | ||
==Value of screening== | |||
In-spite of identifying patients at increased risk of VTE, there is no clear clinical value for screening the general population because: | |||
* The strongest risk factor for VTE recurrence is a prior VTE event itself. | |||
* VTE patients with unknown cause have a high rate of recurrence, after discontinuation of warfarin, 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?=== | |||
Screening for inherited thrombophilia in patients who have [[DVT]] is discussed [[Thrombophilia#Laboratory testing|here]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
Revision as of 17:25, 14 May 2012
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Pre-test probability
In a patient with suspected DVT, establishing pre-test probability helps in early risk stratification and appropriate use of laboratory tests and imaging modalities.
Wells Score
Wells score is the most widely used tool to assess pre-test probability. It includes 10 clinical questions, with the score ranging from -2 to 9.
Wells score Calculator for DVT
| Variable | Wells[1][2] |
|---|---|
| Active cancer (treatment within last 6 months or palliative) | 1 |
| Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) | 1 |
| Collateral superficial veins (non-varicose) | 1 |
| Pitting edema (confined to symptomatic leg) | 1 |
| Swelling of entire leg | 1 |
| Localized pain along distribution of deep venous system | 1 |
| Paralysis, paresis, or recent cast immobilization of lower extremities | 1 |
| Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks | 1 |
| Previously documented DVT | 1 |
| Alternative diagnosis at least as likely | - 2 |
Interpretation
- High probability: ≥ 3 (Prevalence of DVT - 53%)
- Moderate probability: 1-2 (Prevalence of DVT - 17%)
- Low probability: ≤ 0 (Prevalence of DVT - 5%)
A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2.
Value of screening
In-spite of identifying patients at increased risk of VTE, there is no clear clinical value for screening the general population because:
- The strongest risk factor for VTE recurrence is a prior VTE event itself.
- VTE patients with unknown cause have a high rate of recurrence, after discontinuation of warfarin, 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?
Screening for inherited thrombophilia in patients who have DVT is discussed here.
References
- ↑ Wells PS, Anderson DR, Bormanis J; et al. (1997). "Value of assessment of pretest probability of deep-vein thrombosis in clinical management". Lancet. 350 (9094): 1795–8. doi:10.1016/S0140-6736(97)08140-3. PMID 9428249.
- ↑ Wells PS, Anderson DR, Rodger M; et al. (2003). "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis". N. Engl. J. Med. 349 (13): 1227–35. doi:10.1056/NEJMoa023153. PMID 14507948. Unknown parameter
|month=ignored (help)