Deep vein thrombosis special scenario upper extremity: Difference between revisions

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Revision as of 11:37, 17 July 2014

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Combined modality ultrasound (compression ultrasound with either Doppler to color Doppler) is the initial test of choice. If the initial ultrasound is negative, but clinical suspicion stays high, further testing with serial ultrasound, D-dimer, or venography should be performed.

2012 VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)^[1]

Ultrasonography in Patients With Upper-Extremity DVT (UEDVT)

Class II
"1. In patients suspected of having UEDVT, we suggest initial evaluation with combined modality US (compression with either Doppler or color Doppler) over other initial tests, including highly sensitive D-dimer or venography . (Level of Evidence: C)"

Clinical Pretest Probability Assessment in Patients With UEDVT

Class I
"1. In patients with suspected UEDVT and an initial negative combined-modality US and subsequent negative moderate or highly sensitive D-dimer or CT or MRI, we recommend no further testing, rather than confirmatory venography. (Level of Evidence: C) '"

Class II
"1. In patients with suspected UEDVT in whom initial US is negative for thrombosis despite a high clinical suspicion of DVT, we suggest further testing with a moderate or highly sensitive D-dimer, serial US, or venographic-based imaging (traditional, CT scan, or MRI), rather than no further testing. (Level of Evidence: C)"
"2. We suggest that patients with an initial combined negative modality US and positive D-dimer or those with less than complete evaluation by US undergo venography rather than no further testing, unless there is an alternative explanation for their symptoms (Level of Evidence: B), in which case testing to evaluate for the presence an alternative diagnosis should be performed. We suggest that patients with a positive D-dimer or those with less than complete evaluation by US but an alternative explanation for their symptoms undergo confirmatory testing and treatment of this alternative explanation rather than venography (Level of Evidence: C). "

Acute Anticoagulation for Patients With UEDVT

Thrombolytic Therapy for the Initial Treatment of Patients With UEDVT

Long-term Anticoagulation for Patients With UEDVT

Prevention of PTS of the Arm

Treatment of Patients With PTS of the Arm

References

↑ Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; et al. (2012). "VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e691S–736S. doi:10.1378/chest.11-2300. PMC 3278054. PMID 22315276.

Template:WH Template:WS

[pmid22315276-1] Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; et al. (2012). "VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e691S–736S. doi:10.1378/chest.11-2300. PMC 3278054. PMID 22315276.

[1]

@@ Line 12: / Line 12: @@
 ==2012 VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)<ref name="pmid22315276">{{cite journal| author=Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO et al.| title=VTE, thrombophilia, antithrombotic therapy, and pregnancy: 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= e691S-736S | pmid=22315276 | doi=10.1378/chest.11-2300 | pmc=PMC3278054 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315276  }} </ref>==
-===Ultrasonography in Patients With Upper-Extremity DVT (UEDVT)      ===
+===Ultrasonography in Patients With Upper-Extremity DVT (UEDVT) ===
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class II]]
+|-
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients suspected of having UEDVT, we suggest initial evaluation with combined modality US (compression with either Doppler or color Doppler) over other initial tests, including highly sensitive D-dimer or venography      . ''([[American College of Chest Physicians#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+|}
-===Clinical Pretest Probability Assessment in Patients With UEDVT      ===
+===Clinical Pretest Probability Assessment in Patients With UEDVT ===
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients with suspected UEDVT and an initial negative combined-modality US and subsequent negative moderate or highly sensitive D-dimer or CT or MRI, we recommend no further testing, rather than confirmatory venography.  ([[American College of Chest Physicians#Level of Evidence|Level of Evidence: C]]) ''''<nowiki>"</nowiki>
+|-
+|}
-===Acute Anticoagulation for Patients With UEDVT      ===
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class II]]
+|-
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with suspected UEDVT in whom initial US is negative for thrombosis despite a high clinical suspicion of DVT, we suggest further testing with a moderate or highly sensitive D-dimer, serial US, or venographic-based imaging (traditional, CT scan, or MRI), rather than no further testing. ''([[American College of Chest Physicians#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that patients with an initial combined negative modality US and positive D-dimer or those with less than complete evaluation by US undergo venography rather than no further testing, unless there is an alternative explanation for their symptoms ''([[American College of Chest Physicians#Level of Evidence|Level of Evidence: B]])'', in which case testing to evaluate for the presence an alternative diagnosis should be performed. We suggest that patients with a positive D-dimer or those with less than complete evaluation by US but an alternative explanation for their symptoms undergo confirmatory testing and treatment of this alternative explanation rather than venography ''([[American College of Chest Physicians#Level of Evidence|Level of Evidence: C]])''. <nowiki>"</nowiki>
+|-
+|}
-===Thrombolytic Therapy for the Initial Treatment of Patients With UEDVT      ===
+===Acute Anticoagulation for Patients With UEDVT===
-===Long-term Anticoagulation for Patients With UEDVT      ===
-===Prevention of PTS of the Arm      ===
+===Thrombolytic Therapy for the Initial Treatment of Patients With UEDVT ===
-===Treatment of Patients With PTS of the Arm      ===
+===Long-term Anticoagulation for Patients With UEDVT===
+===Prevention of PTS of the Arm===
+===Treatment of Patients With PTS of the Arm===
 ==References==