Deep vein thrombosis screening: Difference between revisions

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* 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>
* 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>


* The sensitivity and specificity of compression [[ultrasound]] (CUS) for proximal DVT are high (97% and 98%, 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> 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> <ref name="pmid9546569">{{cite journal |author=Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS |title=Does this patient have deep vein thrombosis? |journal=JAMA |volume=279 |issue=14 |pages=1094–9 |year=1998 |month=April |pmid=9546569 |doi= |url=}}</ref> a meta-analysis reported a sensitivity of 50% to 75% and a specificity of 90% to 95%. <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>
* The sensitivity and specificity of compression [[ultrasound]] (CUS) for proximal DVT are high (97% and 98%, 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> 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><ref name="pmid9546569">{{cite journal |author=Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS |title=Does this patient have deep vein thrombosis? |journal=JAMA |volume=279 |issue=14 |pages=1094–9 |year=1998 |month=April |pmid=9546569 |doi= |url=}}</ref> a meta-analysis reported a sensitivity of 50% to 75% and a specificity of 90% to 95%. <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>


==References==
==References==

Revision as of 19:35, 2 June 2014

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

Deep Vein Thrombosis Microchapters

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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

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IVC Filter

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Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Upper extremity DVT

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Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis screening

Overview

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]

Screening

  • 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]
  • The sensitivity and specificity of compression ultrasound (CUS) for proximal DVT are high (97% and 98%, respectively).[4] On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower;[4][5] a meta-analysis reported a sensitivity of 50% to 75% and a specificity of 90% to 95%. [4]

References

  1. ↑ 1.0 1.1 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. ↑ 2.0 2.1 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. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 4.2 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)
  5. ↑ 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)

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