Deep vein thrombosis diagnostic approach: Difference between revisions
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CUS stands for Compression Ultrasonography; D-dimer is the highly sensitive assay. | CUS stands for Compression Ultrasonography; D-dimer is the highly sensitive assay. | ||
Clinical judgement and local availability should be considered in patients with moderate probability of DVT. CUS may be preferred in patients with comorbid conditions associated with elevated D-dimer levels. | |||
Adapted from ACCP guidelines<ref name="pmid22315267">{{cite journal |author=Bates SM, Jaeschke R, Stevens SM, ''et al.'' |title=Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e351S–418S |year=2012 |month=February |pmid=22315267 |doi=10.1378/chest.11-2299 |url=}}</ref>. | Adapted from ACCP guidelines<ref name="pmid22315267">{{cite journal |author=Bates SM, Jaeschke R, Stevens SM, ''et al.'' |title=Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e351S–418S |year=2012 |month=February |pmid=22315267 |doi=10.1378/chest.11-2299 |url=}}</ref>. | ||
==Considerations== | |||
* Whole-leg ultrasound may be preferred in those who have severe symptoms of calf DVT or are unable to come for serial testing. | |||
* CT scan venography, MR venography, or MR direct thrombus imaging may be used in those patients in whom ultrasound is not practical (leg cast, excessive edema) or non-diagnostic. | |||
==References== | ==References== | ||
Revision as of 20:33, 14 May 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]; Kashish Goel, M.D.
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Overview
A number of invasive (venography) and non-invasive tests are possible (impedance plethysmography, compression ultrasonography, D-dimer testing) for diagnosis. Compression ultrasonography is the noninvasive diagnosis of choice for patients with a first episode of suspected DVT.
In a patient population with a high prevalence of venous thromboembolism, a negative D-dimer assay may be insufficient to rule out DVT as a single test , and moreover not all D-dimer assays are validated for this. However, a D-dimer level <500 ng/mL by ELISA along with a low clinical probability (Wells score) or other negative non-invasive tests may be useful in excluding DVT, without doing ultrasound.
In patients with a first episode of DVT, a positive noninvasive study usually confirms the diagnosis. Compression ultrasonography has a positive predictive value of 94 percent (95% CI: 87-98 percent). In situation where the initial investigation was negative but the clinical suspicion of DVT is high, a repeat study should be done within a week. Complete lower extremity ultrasonography may eliminate the need for repeat testing, but a positive compression ultrasonography demands user expertise, and requires specialized instrumentation. The algorithm below presents a possible diagnostic approach.
CUS stands for Compression Ultrasonography; D-dimer is the highly sensitive assay.
Clinical judgement and local availability should be considered in patients with moderate probability of DVT. CUS may be preferred in patients with comorbid conditions associated with elevated D-dimer levels.
Adapted from ACCP guidelines[1].
Considerations
- Whole-leg ultrasound may be preferred in those who have severe symptoms of calf DVT or are unable to come for serial testing.
- CT scan venography, MR venography, or MR direct thrombus imaging may be used in those patients in whom ultrasound is not practical (leg cast, excessive edema) or non-diagnostic.
References
- ↑ Bates SM, Jaeschke R, Stevens SM; et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–418S. doi:10.1378/chest.11-2299. PMID 22315267. Unknown parameter
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