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Articles: Clive Kearon, Jeffrey S. Ginsberg, James Douketis, Mark A. Crowther, Alexander G. Turpie, Shannon M. Bates, Agnes Lee, Patrick Brill-Edwards, Terri Finch, and Michael 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 2005; 142: 490-496 [Abstract] [Full text] [PDF]

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Single complete ultrasound as an option to refute suspected symptomatic DVT

Scott M Stevens, C. Gregory Elliott, MD   (13 May 2005)

Single complete ultrasound as an option to refute suspected symptomatic DVT 13 May 2005
Scott M Stevens, MD LDS Hospital, C. Gregory Elliott, MD Send rapid response to journal: Re: Single complete ultrasound as an option to refute suspected symptomatic DVT ldssteve{at}ihc.com Scott M Stevens, et al.	We appreciate the contribution of Dr. Kearon and colleagues of a new diagnostic approach to suspected deep vein thrombosis [1]. The “one stop” diagnostic strategy [2] of the combination of negative proximal ultrasound followed by d-dimer (and venography if abnormal) is a very useful strategy, especially in those patients whose ability to follow-up for a second proximal ultrasound is uncertain. We would also point out that single complete ultrasound has three prospective trials demonstrating similar diagnostic efficacy [3-5], and believe this strategy should be added to the menu of “one stop” diagnostic options in centers where a complete ultrasound technique is available. This strategy does result in detection of isolated calf vein thrombosis, an entity whose management includes several potential strategies: (1) anticoagulation (2) repeat compression ultrasonography to detect extension to the proximal segments or (3) venography before giving anticoagulants. 1. Kearon C, Ginsberg JS, Douketis J, Crowther MA, Turpie AG, Bates SM, et al. 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. 2005;142:490-6. 2. Hull R.. Revisiting the Past Strengthens the Present: An Evidence -Based Medicine Approach for the Diagnosis of Deep Vein Thrombosis. Ann Intern Med. 2005;142:583-5. 3. Stevens SM, Elliott CG, Chan KJ, Egger MJ, Ahmed KM. Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis. Ann Intern Med. 2004;140:985 -91. 4. Schellong SM, Schwarz T, Halbritter K, Beyer J, Siegert G, Oettler W, et al. Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis. Thromb Haemost. 2003;89:228-34. 5. Elias A, Mallard L, Elias M, Alquier C, Guidolin F, Gauthier B, et al. A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs. Thromb Haemost. 2003;89:221-7. Conflict of Interest: None declared