Deep vein thrombosis screening
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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Diagnosis |
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Treatment |
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Special Scenario |
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Trials |
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Case Studies |
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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) <ref>Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med 1998;129:1044–1049<ref> and the necessity for treating proximal DVT with anticoagulants is widely accepted <ref>Brandjes DP, Heijboer H, Buller HR, de Rijk M, Jagt H, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal vein thrombosis. N Engl J Med 1992;327:1485–1489<ref>. On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower [1,3] and a meta-analysis by Kearon et al. 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>Haut ER, Schneider EB, Patel A, Streiff MB, Haider AH, Stevens KA, Chang DC, Neal ML, Hoeft C, Nathens AB, Cornwell EE 3rd, Pronovost PJ, Efron DT. J Trauma 2011;70(1):27-33<ref>.
Who should be screened?
Screening for inherited thrombophilia in patients who have DVT is discussed here.