Deep vein thrombosis screening: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
__NOTOC__ | |||
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org]; '''Associate Editor(s)-In-Chief:''' {{CZ}} [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]] | '''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org]; '''Associate Editor(s)-In-Chief:''' {{CZ}} [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]; [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]] | ||
{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
==Value of screening== | ==Overview== | ||
==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: | 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. | * The strongest risk factor for VTE recurrence is a prior VTE event itself. | ||
| Line 8: | Line 13: | ||
* Anticoagulant prophylaxis is rarely recommended in asymptomatic affected family members, outside of high risk situations. | * Anticoagulant prophylaxis is rarely recommended in asymptomatic affected family members, outside of high risk situations. | ||
==Screening methods== | ===Screening methods=== | ||
Ultrasound is a first-line method for screening for [[deep vein thrombosis]] (DVT), which may be required more than once. While uncommon, other tests may be required if the ultrasound results are unclear, including: | Ultrasound is a first-line method for screening for [[deep vein thrombosis]] (DVT), which may be required more than once. While uncommon, other tests may be required if the ultrasound results are unclear, including: | ||
* [[D-dimer test]] | * [[D-dimer test]] | ||
| Line 20: | Line 25: | ||
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>. | 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?=== | ||
Screening for inherited thrombophilia in patients who have [[DVT]] is discussed [[Thrombophilia#Laboratory testing|here]]. | Screening for inherited thrombophilia in patients who have [[DVT]] is discussed [[Thrombophilia#Laboratory testing|here]]. | ||
Revision as of 15:11, 26 September 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
|
Deep Vein Thrombosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenario |
|
Trials |
|
Case Studies |
|
Deep vein thrombosis screening On the Web |
|
Risk calculators and risk factors for Deep vein thrombosis screening |
Overview
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
Ultrasound is a first-line method for screening for deep vein thrombosis (DVT), which may be required more than once. While uncommon, other tests may be required if the ultrasound results are unclear, including:
- D-dimer test
- Magnetic resonance imaging (MRI).
- Computed tomography (CT).
- Venogram.
The sensitivity and specificity of compression ultrasound (CUS) for proximal DVT are high (97% and 98%, 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] [3], and a meta-analysis reported sensitivity of 50% to 75% and specificity of 90% to 95% [1]. DVT can be ruled out in a patient who is judged clinically unlikely to have DVT and who has a negative D-dimer test. Ultrasound testing can be safely omitted in such patients.[4]
Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States [5].
Who should be screened?
Screening for inherited thrombophilia in patients who have DVT is discussed here.
References
- ↑ 1.0 1.1 1.2 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) - ↑ Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS (1998). "Does this patient have deep vein thrombosis?". JAMA. 279 (14): 1094–9. PMID 9546569. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ 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)