 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 April 1998 | Volume 128 Issue 8 | Pages 663-677
Purpose: To review noninvasive methods for diagnosis of first and recurrent deep venous thrombosis and provide evidence-based recommendations for the diagnosis of deep venous thrombosis in symptomatic, asymptomatic, and pregnant patients.
Data Sources: Accuracy (comparison with contrast venography) and management (safety of withholding anticoagulants when results were normal) studies that evaluated tests for diagnosis of deep venous thrombosis were identified from a MEDLINE search, personal files, and bibliographies of reviews and original studies.
Study Selection: Prospective cohort studies (accuracy and management studies) and randomized comparisons (management studies) that satisfied predefined methodologic criteria were included.
Data Extraction: Sensitivity, specificity, and positive and negative predictive values were determined for accuracy studies. Rates of venous thromboembolism during long-term follow-up of patients with normal results were determined for management studies.
Data Synthesis: Data from individual studies were combined under a random-effects model. The accuracy of noninvasive tests was compared, with emphasis on within-study comparisons. Recommendations for diagnosis of deep venous thrombosis were developed by a multidisciplinary group and graded according to the strength of the supporting evidence.
Venous ultrasonography is the most accurate noninvasive test for the diagnosis of a first symptomatic proximal deep venous thrombosis.However, neither ultrasonography nor impedance plethysmography is accurate in asymptomatic postoperative patients. Venous ultrasonography is less accurate for symptomatic isolated distal (calf) deep venous thrombosis than for proximal deep venous thrombosis, and the clinical utility of venous ultrasonography of the distal veins is uncertain. Withholding anticoagulant therapy in symptomatic patients with suspected deep venous thrombosis who have normal results on serial venous ultrasonography or impedance plethysmography is safe. Diagnosis of recurrent deep venous thrombosis requires evidence of new thrombus formation, such as a new noncompressible venous segment detected by venous ultrasonography, conversion of a normal result on impedance plethysmography to abnormal, or presence of an intraluminal filling defect on venography. Suspected deep venous thrombosis in pregnant patients can usually be managed with serial venous ultrasonography or impedance plethysmography. In symptomatic patients with a suspected first episode of deep venous thrombosis, clinical assessment and D-dimer testing are complementary to testing with venous ultrasonography and impedance plethysmography.
Conclusions: Patients with suspected deep venous thrombosis can usually be managed with noninvasive testing. However, if the results of this testing are nondiagnostic or are discordant with the clinical assessment, venography should be considered.
Author and Article Information
for the McMaster Diagnostic Imaging Practice Guidelines Initiative.
REVIEW
Noninvasive Diagnosis of Deep Venous Thrombosis
For members of the McMaster Diagnostic Imaging Practice Guidelines Initiative, Diagnosis of Deep Venous Thrombosis Working Group, see Appendix.
Grant Support: Dr. Ginsberg is a Career Investigator of the Heart and Stroke Foundation of Ontario. Ms. Newman is supported by the Cancer Care Ontario Practice Guidelines Initiative.
Requests for Reprints: Clive Kearon, MB, PhD, McMaster Medical Unit, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
Current Author Addresses: Dr. Kearon: McMaster Medical Unit, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
This article has been cited by other articles:
|
|
 |
|
  J. Douketis, D. Cook, M. Meade, G. Guyatt, W. Geerts, Y. Skrobik, M. Albert, J. Granton, P. Hebert, G. Pagliarello, et al. Prophylaxis Against Deep Vein Thrombosis in Critically Ill Patients With Severe Renal Insufficiency With the Low-Molecular-Weight Heparin Dalteparin: An Assessment of Safety and Pharmacodynamics: The DIRECT Study Arch Intern Med, September 8, 2008; 168(16): 1805 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Dewar, C Selby, K Jamieson, and S Rogers Emergency department nurse-based outpatient diagnosis of DVT using an evidence-based protocol Emerg. Med. J., July 1, 2008; 25(7): 411 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Falanga, A. Y. Y. Lee, M. B. Streiff, and G. H. Lyman Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer ASCO Educational Book, January 1, 2008; 2008(1): 258 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P S Sidhu, R Alikhan, T Ammar, and D J Quinlan Lower limb contrast venography: a modified technique for use in thromboprophylaxis clinical trials for the accurate evaluation of deep vein thrombosis Br. J. Radiol., November 1, 2007; 80(959): 859 - 865. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Noble The challenges of managing cancer related venous thromboembolism in the palliative care setting Postgrad. Med. J., November 1, 2007; 83(985): 671 - 674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Leizorovicz and SMART Venography Study Steering Committee Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study Haematologica, September 1, 2007; 92(9): 1194 - 1200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.-S. Chan, S. Chunilal, A. Lee, M. Crowther, M. Rodger, and J. S. Ginsberg A Red Blood Cell Agglutination D-Dimer Test to Exclude Deep Venous Thrombosis in Pregnancy Ann Intern Med, August 7, 2007; 147(3): 165 - 170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Agnelli, A. Gallus, S. Z. Goldhaber, S. Haas, M. V. Huisman, R. D. Hull, A. K. Kakkar, F. Misselwitz, S. Schellong, and for the ODIXa-DVT Study Investigators Treatment of Proximal Deep-Vein Thrombosis With the Oral Direct Factor Xa Inhibitor Rivaroxaban (BAY 59-7939): The ODIXa-DVT (Oral Direct Factor Xa Inhibitor BAY 59-7939 in Patients With Acute Symptomatic Deep-Vein Thrombosis) Study Circulation, July 10, 2007; 116(2): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Fazel, J. B. Froehlich, D. M. Williams, S. Saint, and B. K. Nallamothu A Sinister Development -- A 35-year-old woman presented to the emergency department with a 2-day history of progressive swelling and pain in her left leg, without antecedent trauma N. Engl. J. Med., July 5, 2007; 357(1): 53 - 59. [Full Text] [PDF]
|
|
|
|
|
|
A. Qaseem, V. Snow, P. Barry, E. R. Hornbake, J. E. Rodnick, T. Tobolic, B. Ireland, J. B. Segal, E. B. Bass, K. B. Weiss, et al. Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians Ann Intern Med, March 20, 2007; 146(6): 454 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. C. Krivak and K. K. Zorn Venous Thromboembolism in Obstetrics and Gynecology Obstet. Gynecol., March 1, 2007; 109(3): 761 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Qaseem, V. Snow, P. Barry, E. R. Hornbake, J. E. Rodnick, T. Tobolic, B. Ireland, J. Segal, E. Bass, K. B. Weiss, et al. Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians Ann. Fam. Med, January 1, 2007; 5(1): 57 - 62. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Segal, J. Eng, L. J. Tamariz, and E. B. Bass Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism Ann. Fam. Med, January 1, 2007; 5(1): 63 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Crowther and T. C. Abshire Hemostasis and thrombosis ASH Self-Assessment Program, January 1, 2007; 2007(1): 361 - 407. [Full Text] [PDF]
|
|
|
|
|
|
A. G G Turpie and A. Leizorovicz Prevention of venous thromboembolism in medically ill patients: a clinical update Postgrad. Med. J., December 1, 2006; 82(974): 806 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Scarvelis and P. S. Wells Diagnosis and treatment of deep-vein thrombosis. Can. Med. Assoc. J., October 24, 2006; 175(9): 1087 - 1092. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kearon, J. S. Ginsberg, J. A. Julian, J. Douketis, S. Solymoss, P. Ockelford, S. Jackson, A. G. Turpie, B. MacKinnon, J. Hirsh, et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA, August 23, 2006; 296(8): 935 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon, J. S. Ginsberg, J. Douketis, A. G. Turpie, S. M. Bates, A. Y. Lee, M. A. Crowther, J. I. Weitz, P. Brill-Edwards, P. Wells, et al. An evaluation of D-dimer in the diagnosis of pulmonary embolism: a randomized trial. Ann Intern Med, June 6, 2006; 144(11): 812 - 821. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Thromboembolism after pneumonectomy for malignancy: An independent marker of poor outcome. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 711 - 718.
|
|
|
|
|
|
P. S. Wells, C. Owen, S. Doucette, D. Fergusson, and H. Tran Does This Patient Have Deep Vein Thrombosis? JAMA, January 11, 2006; 295(2): 199 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F C Sampson, S Goodacre, A-M Kelly, and D Kerr How is deep vein thrombosis diagnosed and managed in UK and Australian emergency departments? Emerg. Med. J., November 1, 2005; 22(11): 780 - 782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Subramaniam, R. Heath, T. Chou, K. Cox, G. Davis, and M. Swarbrick Deep Venous Thrombosis: Withholding Anticoagulation Therapy after Negative Complete Lower Limb US Findings Radiology, October 1, 2005; 237(1): 348 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Fuchs, T. Heyse, G. Rudofsky, G. Gosheger, and C. Chylarecki Continuous passive motion in the prevention of deep-vein thrombosis: A RANDOMISED COMPARISON IN TRAUMA PATIENTS J Bone Joint Surg Br, August 1, 2005; 87-B(8): 1117 - 1122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Goodacre, F.C. Sampson, A.J. Sutton, S. Mason, and F. Morris Variation in the diagnostic performance of D-dimer for suspected deep vein thrombosis QJM, July 1, 2005; 98(7): 513 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Patel and E. A. Kazerooni Helical CT for the Evaluation of Acute Pulmonary Embolism Am. J. Roentgenol., July 1, 2005; 185(1): 135 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon, J. S. Ginsberg, J. Douketis, M. A. Crowther, A. G. Turpie, S. M. Bates, A. Lee, P. Brill-Edwards, T. Finch, and M. Gent A Randomized Trial of Diagnostic Strategies after Normal Proximal Vein Ultrasonography for Suspected Deep Venous Thrombosis: D-Dimer Testing Compared with Repeated Ultrasonography Ann Intern Med, April 5, 2005; 142(7): 490 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Hull Revisiting the Past Strengthens the Present: An Evidence-Based Medicine Approach for the Diagnosis of Deep Venous Thrombosis Ann Intern Med, April 5, 2005; 142(7): 583 - 585. [Full Text] [PDF]
|
|
|
|
 |
|
 T. L Fancher, R. H White, and R. L Kravitz Combined use of rapid D-dimer testing and estimation of clinical probability in the diagnosis of deep vein thrombosis: systematic review BMJ, October 9, 2004; 329(7470): 821. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L.-A. Linkins, P. Pasquale, S. Paterson, and C. Kearon Change in Thrombus Length on Venous Ultrasound and Recurrent Deep Vein Thrombosis Arch Intern Med, September 13, 2004; 164(16): 1793 - 1796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H. Geerts, G. F. Pineo, J. A. Heit, D. Bergqvist, M. R. Lassen, C. W. Colwell, and J. G. Ray Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 338S - 400S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G.G. Turpie, K. A. Bauer, B. I. Eriksson, and M. R. Lassen Superiority of Fondaparinux Over Enoxaparin in Preventing Venous Thromboembolism in Major Orthopedic Surgery Using Different Efficacy End Points Chest, August 1, 2004; 126(2): 501 - 508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates and J. S. Ginsberg Treatment of Deep-Vein Thrombosis N. Engl. J. Med., July 15, 2004; 351(3): 268 - 277. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Stevens, C. G. Elliott, K. J. Chan, M. J. Egger, and K. M. Ahmed Withholding Anticoagulation after a Negative Result on Duplex Ultrasonography for Suspected Symptomatic Deep Venous Thrombosis Ann Intern Med, June 15, 2004; 140(12): 985 - 991. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. El Kheir and H. Buller One-Time Comprehensive Ultrasonography To Diagnose Deep Venous Thrombosis: Is That the Solution? Ann Intern Med, June 15, 2004; 140(12): 1052 - 1053. [Full Text] [PDF]
|
|
|
|
|
|
M Riedel Diagnosing pulmonary embolism Postgrad. Med. J., June 1, 2004; 80(944): 309 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Zierler Ultrasonography and Diagnosis of Venous Thromboembolism Circulation, March 30, 2004; 109(12_suppl_1): I-9 - I-14. [Abstract] [Full Text]
|
|
|
|
|
|
M. Ambrosetti, M. Salerno, M. Zambelli, F. Mastropasqua, R. Tramarin, and R. F. E. Pedretti Deep Vein Thrombosis Among Patients Entering Cardiac Rehabilitation After Coronary Artery Bypass Surgery Chest, January 1, 2004; 125(1): 191 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Cox, S. S. Carson, and A. K. Biddle Cost-effectiveness of Ultrasound in Preventing Femoral Venous Catheter-associated Pulmonary Embolism Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1481 - 1487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. G. Turpie, B. I. Eriksson, K. A. Bauer, and M. R. Lassen New Pentasaccharides for the Prophylaxis of Venous Thromboembolism: Clinical Studies Chest, December 1, 2003; 124(6_suppl): 371S - 378S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Wells, D. R. Anderson, M. Rodger, M. Forgie, C. Kearon, J. Dreyer, G. Kovacs, M. Mitchell, B. Lewandowski, and M. J. Kovacs Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis N. Engl. J. Med., September 25, 2003; 349(13): 1227 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Quinlan, R. Alikhan, P. Gishen, and P. S. Sidhu Variations in Lower Limb Venous Anatomy: Implications for US Diagnosis of Deep Vein Thrombosis Radiology, August 1, 2003; 228(2): 443 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon Natural History of Venous Thromboembolism Circulation, June 17, 2003; 107(90231): I-22 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, C. Kearon, M. Crowther, L. Linkins, M. O'Donnell, J. Douketis, A. Y.Y. Lee, J. I. Weitz, M. Johnston, and J. S. Ginsberg A Diagnostic Strategy Involving a Quantitative Latex D-Dimer Assay Reliably Excludes Deep Venous Thrombosis Ann Intern Med, May 20, 2003; 138(10): 787 - 794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, J. Lister-James, J. A. Julian, R. Taillefer, B. R. Moyer, and J. S. Ginsberg Imaging Characteristics of a Novel Technetium Tc 99m-Labeled Platelet Glycoprotein IIb/IIIa Receptor Antagonist in Patients With Acute Deep Vein Thrombosis or a History of Deep Vein Thrombosis Arch Intern Med, February 24, 2003; 163(4): 452 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon Diagnosis of pulmonary embolism Can. Med. Assoc. J., January 21, 2003; 168(2): 183 - 194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Leizorovicz, B. Kassai, F. Becker, and M. Cucherat The Assessment of Deep Vein Thromboses for Therapeutic Trials Angiology, January 1, 2003; 54(1): 19 - 24. [Abstract] [PDF]
|
|
|
|
 |
|
 S. M. Bates and J. S. Ginsberg How we manage venous thromboembolism during pregnancy Blood, November 15, 2002; 100(10): 3470 - 3478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. G. Turpie, K. A. Bauer, B. I. Eriksson, M. R. Lassen, and for the Steering Committees of the Pentasaccharide Fondaparinux vs Enoxaparin for the Prevention of Venous Thromboembolism in Major Orthopedic Surgery: A Meta-analysis of 4 Randomized Double-blind Studies Arch Intern Med, September 9, 2002; 162(16): 1833 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Noren, E. Ottosson, and S. Rosfors Is It Safe to Withhold Anticoagulation Based on a Single Negative Color Duplex Examination in Patients with Suspected Deep Venous Thrombosis? A Prospective 3-Month Follow-up Study Angiology, September 1, 2002; 53(5): 521 - 527. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Kearon Magnetic resonance direct thrombus imaging was accurate in suspected deep venous thrombosis Evid. Based Med., July 1, 2002; 7(4): 126 - 126. [Full Text] [PDF]
|
|
|
|
|
|
J. Miller, B. K.S. Chan, and H. D. Nelson Postmenopausal Estrogen Replacement and Risk for Venous Thromboembolism: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force Ann Intern Med, May 7, 2002; 136(9): 680 - 690. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hirsh and A. Y. Y. Lee How we diagnose and treat deep vein thrombosis Blood, May 1, 2002; 99(9): 3102 - 3110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kelly, A. Rudd, R. R. Lewis, and B. J. Hunt Plasma D-Dimers in the Diagnosis of Venous Thromboembolism Arch Intern Med, April 8, 2002; 162(7): 747 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Song, K. S Khan, J. Dinnes, and A. J Sutton Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy Int. J. Epidemiol., February 1, 2002; 31(1): 88 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Chunilal, P. A. Brill-Edwards, P. B. Stevens, J. P. Joval, J. A. McGinnis, M. Rupwate, and J. S. Ginsberg The Sensitivity and Specificity of a Red Blood Cell Agglutination D-Dimer Assay for Venous Thromboembolism When Performed on Venous Blood Arch Intern Med, January 28, 2002; 162(2): 217 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G.W. Fraser, A. R. Moody, P. S. Morgan, A. L. Martel, and I. Davidson Diagnosis of Lower-Limb Deep Venous Thrombosis: A Prospective Blinded Study of Magnetic Resonance Direct Thrombus Imaging Ann Intern Med, January 15, 2002; 136(2): 89 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Schwarz, B. Schmidt, B. Schmidt,, and S. M. Schellong Interobserver Agreement of Complete Compression Ultrasound for Clinically Suspected Deep Vein Thrombosis Clinical and Applied Thrombosis/Hemostasis, January 1, 2002; 8(1): 45 - 49. [Abstract] [PDF]
|
|
|
|
|
|
J. Kelly, A. Rudd, R.R. Lewis, and B.J. Hunt Screening for subclinical deep-vein thrombosis QJM, October 1, 2001; 94(10): 511 - 519. [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon, J. S. Ginsberg, J. Douketis, M. Crowther, P. Brill-Edwards, J. I. Weitz, and J. Hirsh Management of Suspected Deep Venous Thrombosis in Outpatients by Using Clinical Assessment and D-dimer Testing Ann Intern Med, July 17, 2001; 135(2): 108 - 111. [Abstract] [Full Text] [PDF]
|
|
Article
