Deep vein thrombosis screening: Difference between revisions
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==Screening methods== | ==Screening methods== | ||
The sensitivity and specificity of compression ultrasound(CUS) for proximal [[deep vein thrombosis]] (DVT) are high (97 percent and 98 percent, respectively) <ref>{{cite journal |author=Kearon C, Ginsberg JS, Hirsh J |title=The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism |journal=Ann. Intern. Med. |volume=129 |issue=12 |pages=1044–9 |year=1998 |month=December |pmid=9867760 |doi= |url=}}<ref> and the necessity for treating proximal DVT with anticoagulants is widely accepted <ref>{{cite journal |author=Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW |title=Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis |journal=N. Engl. J. Med. |volume=327 |issue=21 |pages=1485–9 |year=1992 |month=November |pmid=1406880 |doi=10.1056/NEJM199211193272103 |url=}}<ref>. On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower <ref>{{cite journal |author=Kearon C, Ginsberg JS, Hirsh J |title=The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism |journal=Ann. Intern. Med. |volume=129 |issue=12 |pages=1044–9 |year=1998 |month=December |pmid=9867760 |doi= |url=}}<ref> and a meta-analysis by reported sensitivity of 50 percent to 75 percent and specificity of 90 percent to 95 percent | The sensitivity and specificity of compression ultrasound(CUS) for proximal [[deep vein thrombosis]] (DVT) are high (97 percent and 98 percent, respectively) <ref name="pmid9867760">{{cite journal |author=Kearon C, Ginsberg JS, Hirsh J |title=The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism |journal=Ann. Intern. Med. |volume=129 |issue=12 |pages=1044–9 |year=1998 |month=December |pmid=9867760 |doi= |url=}}</ref> and the necessity for treating proximal DVT with anticoagulants is widely accepted <ref name="pmid1406880">{{cite journal |author=Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW |title=Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis |journal=N. Engl. J. Med. |volume=327 |issue=21 |pages=1485–9 |year=1992 |month=November |pmid=1406880 |doi=10.1056/NEJM199211193272103 |url=}}</ref>. On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower <ref name="pmid9867760">{{cite journal |author=Kearon C, Ginsberg JS, Hirsh J |title=The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism |journal=Ann. Intern. Med. |volume=129 |issue=12 |pages=1044–9 |year=1998 |month=December |pmid=9867760 |doi= |url=}}</ref> and a meta-analysis by reported sensitivity of 50 percent to 75 percent and specificity of 90 percent to 95 percent | ||
Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States <ref>{{cite journal |author=Haut ER, Schneider EB, Patel A, ''et al.'' |title=Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices |journal=J Trauma |volume=70 |issue=1 |pages=27–33; discussion 33–4 |year=2011 |month=January |pmid=21217477 |doi=10.1097/TA.0b013e3182077d55 |url=}}<ref>. | Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States <ref name="pmid21217477">{{cite journal |author=Haut ER, Schneider EB, Patel A, ''et al.'' |title=Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices |journal=J Trauma |volume=70 |issue=1 |pages=27–33; discussion 33–4 |year=2011 |month=January |pmid=21217477 |doi=10.1097/TA.0b013e3182077d55 |url=}}</ref>. | ||
==Who should be screened?== | ==Who should be screened?== | ||
Revision as of 17:27, 16 June 2012
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] Ujjwal Rastogi, MBBS [3]; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep Vein Thrombosis Microchapters |
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Deep vein thrombosis screening On the Web |
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Risk calculators and risk factors for Deep vein thrombosis screening |
Value of screening
In-spite of identifying patients at increased risk of venous thromboembolism (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.
Screening methods
The sensitivity and specificity of compression ultrasound(CUS) for proximal deep vein thrombosis (DVT) are high (97 percent and 98 percent, respectively) [1] and the necessity for treating proximal DVT with anticoagulants is widely accepted [2]. On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower [1] and a meta-analysis by reported sensitivity of 50 percent to 75 percent and specificity of 90 percent to 95 percent
Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States [3].
Who should be screened?
Screening for inherited thrombophilia in patients who have DVT is discussed here.
References
- ↑ 1.0 1.1 Kearon C, Ginsberg JS, Hirsh J (1998). "The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism". Ann. Intern. Med. 129 (12): 1044–9. PMID 9867760. Unknown parameter
|month=ignored (help) - ↑ Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW (1992). "Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis". N. Engl. J. Med. 327 (21): 1485–9. doi:10.1056/NEJM199211193272103. PMID 1406880. Unknown parameter
|month=ignored (help) - ↑ Haut ER, Schneider EB, Patel A; et al. (2011). "Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices". J Trauma. 70 (1): 27–33, discussion 33–4. doi:10.1097/TA.0b013e3182077d55. PMID 21217477. Unknown parameter
|month=ignored (help)