Deep vein thrombosis screening: Difference between revisions

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__NOTOC__
__NOTOC__
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}  [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]
{| class="infobox" style="float:right;"
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| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br>
| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}  [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]; {{Rim}}
{{Deep vein thrombosis}}
{{Deep vein thrombosis}}


==Overview==
==Overview==
 
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>
==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===
Ultrasound is a first-line screening method for [[deep vein thrombosis]] (DVT), which may be required more than once. While uncommon, other tests may be required if the ultrasound results are unclear, including:
* [[D-dimer test]]
* [[Magnetic resonance imaging]] (MRI).
* [[Computed tomography]] (CT).
* Venogram.
 
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> and the necessity for treating proximal DVT with anticoagulants is widely accepted. <ref name="pmid1406880">{{cite journal |author=Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW |title=Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis |journal=N. Engl. J. Med. |volume=327 |issue=21 |pages=1485–9 |year=1992 |month=November |pmid=1406880 |doi=10.1056/NEJM199211193272103 |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> and a meta-analysis reported sensitivity of 50% to 75% and 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> DVT can be ruled out in a patient who is judged clinically to not be at a high risk to have a DVT, and who also has a negative D-dimer test. Ultrasound testing can be safely omitted in such patients.<ref name="pmid14507948">{{cite journal |author=Wells PS, Anderson DR, Rodger M, ''et al.'' |title=Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis |journal=N. Engl. J. Med. |volume=349 |issue=13 |pages=1227–35 |year=2003 |month=September |pmid=14507948 |doi=10.1056/NEJMoa023153 |url=}}</ref>
 
Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States <ref name="pmid21217477">{{cite journal |author=Haut ER, Schneider EB, Patel A, ''et al.'' |title=Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices |journal=J Trauma |volume=70 |issue=1 |pages=27–33; discussion 33–4 |year=2011 |month=January |pmid=21217477 |doi=10.1097/TA.0b013e3182077d55 |url=}}</ref>.
 
===Who should be screened?===
Screening for inherited thrombophilia in patients who have [[DVT]] is discussed [[Thrombophilia#Laboratory testing|here]].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Pulmonology]]
[[Category:Angiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Vascular surgery]]
[[Category:Up-To-Date]]
[[Category:Cardiovascular diseases]]
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Latest revision as of 11:58, 13 July 2014
Resident
Survival
Guide

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; Rim Halaby, M.D. [3]

Deep Vein Thrombosis Microchapters

Home

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

Medical Therapy

IVC Filter

Invasive Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT

Recurrence

Pregnancy

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis screening On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis screening

CDC on Deep vein thrombosis screening

Deep vein thrombosis screening in the news

Blogs on Deep vein thrombosis screening

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis screening

Overview

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]

References

  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. ↑ 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. ↑ 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.

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