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] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Overview
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) [1] and the necessity for treating proximal DVT with anticoagulants is widely accepted. [2] On the other hand, the sensitivity and specificity of CUS for distal DVTs are lower, [1] [3] and a meta-analysis reported sensitivity of 50% to 75% and specificity of 90% to 95%. [1] 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.[4]
Duplex ultrasound screening is typically used for DVT in asymptomatic trauma patients, but practice patterns vary in the United States [5].
Who should be screened?
Screening for inherited thrombophilia in patients who have DVT is discussed here.
References
- ↑ 1.0 1.1 1.2 Kearon C, Ginsberg JS, Hirsh J (1998). "The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism". Ann. Intern. Med. 129 (12): 1044–9. PMID 9867760. Unknown parameter
|month=ignored (help) - ↑ Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW (1992). "Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis". N. Engl. J. Med. 327 (21): 1485–9. doi:10.1056/NEJM199211193272103. PMID 1406880. Unknown parameter
|month=ignored (help) - ↑ Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS (1998). "Does this patient have deep vein thrombosis?". JAMA. 279 (14): 1094–9. PMID 9546569. Unknown parameter
|month=ignored (help) - ↑ Wells PS, Anderson DR, Rodger M; et al. (2003). "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis". N. Engl. J. Med. 349 (13): 1227–35. doi:10.1056/NEJMoa023153. PMID 14507948. Unknown parameter
|month=ignored (help) - ↑ Haut ER, Schneider EB, Patel A; et al. (2011). "Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices". J Trauma. 70 (1): 27–33, discussion 33–4. doi:10.1097/TA.0b013e3182077d55. PMID 21217477. Unknown parameter
|month=ignored (help)