1
|
Miyake R, Yamada Y, Yamanaka S, Kawaguchi R, Ootake N, Myoba S, Kobayashi H. Tissue factor pathway inhibitor 2 as a serum marker for diagnosing asymptomatic venous thromboembolism in patients with epithelial ovarian cancer and positive D-dimer results. Mol Clin Oncol 2022; 16:46. [PMID: 35003744 DOI: 10.3892/mco.2021.2479] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022] Open
Abstract
Tissue factor pathway inhibitor 2 (TFPI2) is a serodiagnostic marker for epithelial ovarian cancer (EOC) and is the primary inhibitor of the extrinsic coagulation pathway. The present study assessed the diagnostic performance of TFPI2 for detecting venous thromboembolism (VTE) in patients with EOC and positive D-dimer results (>1.0 µg/ml). First, the clinical data of 81 patients with EOC admitted to Nara Medical University Hospital between January 2008 and December 2015 were collected. Also, 25 patients with VTE and 56 patients without VTE were included. Receiver-operating characteristic (ROC) curve analyses were performed to determine the diagnostic efficacy of TFPI2 in discriminating patients with VTE from those without VTE. Serum TFPI2 levels in patients with VTE were significantly higher than in non-VTE patients (median, 472.2 vs. 279.1 pg/ml, P<0.001). Using the Youden index, the optimal cutoff value for the TFPI2 level was set at 398.9 pg/ml. Furthermore, the sensitivity, specificity, positive predictive value and negative predictive value of TFPI2 for diagnosing VTE were 64.0, 80.4, 59.3 and 83.3%, respectively. Additionally, 80.4% of patients with TFPI2 levels <398.9 pg/ml were VTE-negative. ROC analysis demonstrated that the area under the curve for TFPI2 was 0.729 (95% confidence interval, 0.614-0.844). Conclusively, TFPI2 may distinguish patients with VTE from those without VTE among patients with EOC and positive D-dimer results.
Collapse
Affiliation(s)
- Ryuta Miyake
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yuki Yamada
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shoichiro Yamanaka
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Norihisa Ootake
- Bioscience Division, Research and Development Department, Tosoh Corporation, Ayase-shi, Kanagawa 252-1123, Japan
| | - Shohei Myoba
- Bioscience Division, Research and Development Department, Tosoh Corporation, Ayase-shi, Kanagawa 252-1123, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan.,Department of Gynecology, Ms.Clinic MayOne, Kashihara, Nara 634-0813, Japan
| |
Collapse
|
2
|
Durmaz F, Gultekin MA. Efficacy of Shear Wave Elastography in the Differentiation of Acute and Subacute Deep Venous Thrombosis. Ultrasound Q 2021; 37:168-172. [PMID: 34057916 DOI: 10.1097/ruq.0000000000000563] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT It is important to know the age of clot formation to determine an appropriate treatment for deep vein thrombosis (DVT). The present study aims to differentiate between acute and subacute DVT using the shear wave elastography (SWE) technique. Patients with complaints no longer than 4 weeks and who were found to have early-stage (acute-subacute) thrombus on ultrasound (US) between January 2020 and May 2020 were included in the study. All of the patients underwent SWE using a Philips Healthcare EPIQ 5 Ultrasound System Inc. device with a high-resolution linear US probe (eL18-4, 22-2 MHz). Included in the study were 50 patients, including 23 with acute DVT and 27 with subacute DVT. Of the patients, 22 were women and 28 were men, and the mean age was 46.32 ± 11.33 years (range: 24-74 years). The mean SWE value was 2.63± 0.16 (2.39-2.96) in patients with acute DVT and 3.34± 0.31 (2.65-3.88) in patients with subacute DVT. The findings were statistically significant in the comparison of the 2 groups using an independent samples t test (P < 0.001). In the receiver operating characteristic analysis, the area under the curve was found to be 97.6%. When the cutoff value was taken as 2.85 according to the area under the curve, sensitivity was found to be 96.3%, and specificity was 91.3%. Thrombus stage plays a critical role in treatment decisions in DVT in the lower extremities. The present study reveals that the shear wave US elastography technique can be used to discriminate between acute and subacute DVT.
Collapse
Affiliation(s)
- Fatma Durmaz
- Department of Radiology, Faculty of Medicine, Van Yuzuncu Yil University, Van
| | - Mehmet Ali Gultekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
3
|
Barfod KW, Nielsen EG, Olsen BH, Vinicoff PG, Troelsen A, Holmich P. Risk of Deep Vein Thrombosis After Acute Achilles Tendon Rupture: A Secondary Analysis of a Randomized Controlled Trial Comparing Early Controlled Motion of the Ankle Versus Immobilization. Orthop J Sports Med 2020; 8:2325967120915909. [PMID: 32426409 PMCID: PMC7222258 DOI: 10.1177/2325967120915909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Immobilization of the ankle joint has been suggested as a key element in the
pathogenesis leading to deep vein thrombosis (DVT). Purpose: To investigate whether early controlled ankle motion (ECM) could reduce the
incidence of DVT compared with immobilization (IM) in the treatment of acute
Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 70 years were eligible for inclusion, and treatment was
nonoperative. The ECM group performed movements of the ankle 5 times a day
from weeks 3 to 8 after rupture. The control group was immobilized for 8
weeks. The outcome measure was DVT diagnosed with color Doppler ultrasound
for above- and below-knee DVT at 2 and 8 weeks. The Achilles tendon Total
Rupture Score, the heel-rise work test, and the Copenhagen Achilles
ultrasonographic Length Measurement were performed at 4-, 6-, and 12-month
follow-up. Results: A total of 189 patients were assessed for eligibility from February 2014 to
December 2016. Of these, 130 were randomized: 68 patients were allocated to
the ECM group and 62 to the IM group. All patients participated in follow-up
at 8 weeks assessing for DVT. In total, 62 (47.7%) patients were diagnosed
with DVT: 33 of 68 (48.5%) in the ECM group and 28 of 61 (46.8%) in the IM
group (P = .84). DVT did not affect treatment outcomes at
4, 6, and 12 months. D-dimer had low sensitivity (71%) for detecting
DVT. Conclusion: We found that 1 in 2 patients presented with DVT in nonoperative treatment of
acute Achilles tendon rupture. The ECM protocol revealed no benefit versus
IM in reducing the incidence of DVT. DVT did not influence functional and
patient-reported outcomes the first year after rupture. D-dimer seems an
inappropriate test for detection of DVT in patients with acute Achilles
tendon rupture. Registration: NCT02015364 (ClinicalTrials.gov
identifier).
Collapse
Affiliation(s)
- Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center-Copenhagen, Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| | - Emil Graakjær Nielsen
- Department of Radiology, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| | - Beth Hærsted Olsen
- Department of Radiology, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| | - Pablo Gustavo Vinicoff
- Department of Radiology, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Amager-Hvidovre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Holmich
- Sports Orthopedic Research Center-Copenhagen, Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| |
Collapse
|
4
|
Canty D, Mufti K, Bridgford L, Denault A. Point-of-care ultrasound for deep venous thrombosis of the lower limb. Australas J Ultrasound Med 2019; 23:111-120. [PMID: 34760590 DOI: 10.1002/ajum.12188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The incidence and morbidity of deep venous thrombosis (DVT) and pulmonary embolus are high. Although efforts to increase screening for DVT have been recommended, this is limited by resources. Venous duplex ultrasound has replaced venography as the first-line investigation of choice for DVT, increasing availability and reducing patient exposure to radiation and intravenous contrast. Furthermore, an abbreviated ultrasound where DVT is inferred from incomplete venous compressibility has an equivalent accuracy to venous duplex, requiring less time and training enabling its widespread use by emergency, critical care and anaesthesia clinicians. In this review, the evolution and method of lower limb venous compression ultrasound is described along with evidence for its use in patients at high risk for DVT in these clinical settings.
Collapse
Affiliation(s)
- David Canty
- Department of Surgery (Royal Melbourne Hospital) University of Melbourne Level 6 Centre for Medical Research, PO Box 2135 Melbourne Victoria 3050 Australia.,Department of Anaesthesia and Pain Management Royal Melbourne Hospital 300 Grattan Street, Parkville Melbourne Victoria 3050 Australia.,Department of Medicine, Nursing and Health Sciences Monash University Wellington Rd Clayton Victoria 3800 Australia.,Department of Anaesthesia and Perioperative Medicine Monash Health 246 Clayton Rd Clayton Victoria 3168 Australia
| | - Kavi Mufti
- Department of Medicine, Nursing and Health Sciences Monash University Wellington Rd Clayton Victoria 3800 Australia.,Intensive Care Unit Frankston Hospital 2 Hastings Road Frankston Victoria 3199 Australia
| | - Lindsay Bridgford
- Department of Surgery (Royal Melbourne Hospital) University of Melbourne Level 6 Centre for Medical Research, PO Box 2135 Melbourne Victoria 3050 Australia.,Department of Emergency Medicine Maroondah Hospital 1-15 Davey Dr Ringwood East Victoria 3135 Australia
| | - André Denault
- Department of Anesthesiology and Critical Care Faculty of Medicine University of Montreal 2900 Edouard Montpetit Blvd Montreal Quebec H3T 1J4 Canada.,Department of Anesthesiology and Critical Care Montreal Heart Institute 5000 Rue Bélanger Montreal Quebec QC H1T 1C8 Canada
| |
Collapse
|
5
|
Santos SND, Alcantara MLD, Freire CMV, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso O, Albricker ACL, Petisco ACGP, Barros FS, Barros MVL, Saleh MH, Vieira MLC. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:809-849. [PMID: 31314836 PMCID: PMC6636370 DOI: 10.5935/abc.20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Salomon Israel do Amaral
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | | | - Marcelo Luiz Campos Vieira
- Universidade de São Paulo (USP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil
| |
Collapse
|
6
|
Baker E, Wagner M. Bedside Diagnosis of Deep Vein Thrombosis Using a Pocket-Sized Ultrasound Device. Am J Med 2018; 131:e95-e96. [PMID: 29030060 DOI: 10.1016/j.amjmed.2017.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Elizabeth Baker
- University of South Carolina School of Medicine/Palmetto Health, Columbia
| | - Michael Wagner
- University of South Carolina School of Medicine/Palmetto Health, Columbia.
| |
Collapse
|
7
|
Aslan A, Barutca H, Ayaz E, Aslan M, Kocaaslan C, Inan I, Sahin S, Yıkılmaz A. Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:116-121. [PMID: 28940429 DOI: 10.1002/jcu.22522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/30/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real-time elastography (RTE). METHODS Fifty-eight patients with acute or subacute DVT were prospectively evaluated by B-mode sonography (US), color Doppler US (CDUS), and RTE. Two radiologists evaluated the thrombus echogenicity, compressibility, and recanalization of the affected vein, and thrombus stiffness in consensus. The thrombi were classified into 3 groups as soft, intermediate, and hard on RTE images. RESULTS The final study group consisted of 30 patients with acute DVT, among whom 10 were women (33%), and 19 patients with subacute DVT, among whom 6 were women (32%). The presence of hypoechoic thrombus, incompressible vein, and absence of recanalization on US and CDUS were significantly associated with acute DVT (P < .001 for all variables). The differences in elasticity pattern of the thrombi between acute and subacute DVT were not significant (P = .202). CONCLUSION Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT.
Collapse
Affiliation(s)
- Ahmet Aslan
- Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey
| | - Hakan Barutca
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey
| | - Ercan Ayaz
- Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
| | - Mine Aslan
- Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
- Department of Radiology, Ümraniye Training and Research Hospital, Ümraniye, Istanbul, Turkey
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey
| | - Ibrahim Inan
- Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
| | - Sinan Sahin
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey
| | - Ali Yıkılmaz
- Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
| |
Collapse
|
8
|
Pomero F, Borretta V, Bonzini M, Melchio R, Douketis JD, Fenoglio LM, Dentali F. Accuracy of emergency physician–performed ultrasonography in the diagnosis of deep-vein thrombosis. Thromb Haemost 2017; 109:137-45. [DOI: 10.1160/th12-07-0473] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/14/2012] [Indexed: 11/05/2022]
Abstract
SummaryDuplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician–performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT. The MEDLINE and EMBASE databases (up to August 2012) were systematically searched for studies evaluating the accuracy of EPPU compared to either colour-flow duplex ultrasound performed by a radiology department or vascular laboratory, or to angiography, in the diagnosis of DVT. Weighted mean sensitivity and specificity and associated 95% confidence intervals (CIs) were calculated using a bivariate random-effects regression approach. There were 16 studies included, with 2,379 patients. The pooled prevalence of DVT was 23.1% (498 in 2,379 patients), ranging from 7.4% to 47.3%. Using the bivariate approach, the weighted mean sensitivity of EPPU compared to the reference imaging test was 96.1% (95%CI 90.6–98.5%), and with a weighted mean specificity of 96.8% (95%CI:94.6–98.1%). Our findings suggest that EPPU may be useful in the management of patients with suspected DVT. Future prospective studies are warranted to confirm these findings.
Collapse
|
9
|
Arverud ED, Anundsson P, Hardell E, Barreng G, Edman G, Latifi A, Labruto F, Ackermann PW. Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture. Bone Joint J 2017; 98-B:1635-1641. [PMID: 27909125 DOI: 10.1302/0301-620x.98b12.bjj-2016-0008.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/11/2016] [Indexed: 12/20/2022]
Abstract
AIMS Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions. PATIENTS AND METHODS A total of 111 patients (95 men, 16 women; mean age 40.3, standard deviation 8.4) with an acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Predictors of ACOS included treatment; gender; age; smoking; body mass index; time to surgery; physical activity level pre- and post-injury; symptoms; quality of life and incidence of DVT. RESULTS There were three independent variables that correlated significantly with the dichotomised outcome score (ACOS), while there was no correlation with other factors. An age of less than 40 years old was the strongest independent predictor of a good outcome one year after ATR (odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08 to 0.51), followed by female gender (OR) 4.18, 95% CI 1.01 to 17.24). Notably, patients who did not have a DVT while immobilised post-operatively had a better outcome (OR 0.31, 95% CI 0.12 to 0.80). CONCLUSION Over the age of 40 years, male gender and having a DVT while immobilised are independent negative predictors of outcome in patients with an acute ATR. Cite this article: Bone Joint J 2016;98-B:1635-41.
Collapse
Affiliation(s)
- E Domeij- Arverud
- Karolinska Institutet, Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - P Anundsson
- Karolinska Institutet, Department of Orthopaedics, Stockholm, Sweden
| | - E Hardell
- Karolinska Institutet, Capio Artro Clinic, Stockholm, Sweden
| | - G Barreng
- Karolinska Institutet, Capio Artro Clinic, Stockholm, Sweden
| | - G Edman
- Karolinska Institutet, Tiohunder Hospital, Norrtälje, Sweden
| | - A Latifi
- Karolinska Institutet, Section of Diagnostic Imaging, Karolinska University Hospital, Stockholm, Sweden
| | - F Labruto
- Karolinska Institutet, Section of Diagnostic Imaging, Karolinska University Hospital, Stockholm, Sweden
| | - P W Ackermann
- Karolinska Institutet, Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
10
|
Domeij-Arverud E, Labruto F, Latifi A, Nilsson G, Edman G, Ackermann PW. Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation. Bone Joint J 2015; 97-B:675-80. [DOI: 10.1302/0301-620x.97b5.34581] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Deep vein thrombosis is a common complication of immobilising the lower limb after surgery. We hypothesised that intermittent pneumatic compression (IPC) therapy in outpatients who had undergone surgical repair of acute ruptures of the Achilles tendon could reduce the incidence of this problem. A total of 150 patients who had undergone surgical repair of the Achilles tendon were randomised to either treatment with IPC for six hours per day (n = 74) under an orthosis or treatment as usual (n = 74) in a plaster cast without IPC. At two weeks post-operatively, the incidence of deep vein thrombosis was assessed using blinded, double-reported compression duplex ultrasound. At this point, IPC was discontinued and all patients were immobilised in an orthosis for a further four weeks. At six weeks post-operatively, a second compression duplex ultrasound scan was performed. At two weeks, the incidence of deep vein thrombosis was 21% in the treated group and 37% in the control group (p = 0.042). Age over 39 years was found to be a strong risk factor for deep vein thrombosis (odds ratio (OR) = 4.84, 95% confidence interval (CI) 2.14 to 10.96). Treatment with IPC, corrected for age differences between groups, reduced the risk of deep vein thrombosis at the two-week point (OR = 2.60; 95% CI 1.15 to 5.91; p =0.022). At six weeks, the incidence of deep vein thrombosis was 52% in the treated group and 48% in the control group (OR 0.94, 95% CI 0.49 to 1.83). IPC appears to be an effective method of reducing the risk of deep vein thrombosis in the early stages of post-operative immobilisation of outpatients. Further research is necessary to elucidate whether it can confer similar benefits over longer periods of immobilisation and in a more heterogeneous group of patients. Cite this article: Bone Joint J 2015;97-B:675–80.
Collapse
Affiliation(s)
| | - F. Labruto
- Karolinska Institutet, Stockholm, 171
76, Sweden
| | - A. Latifi
- Karolinska Institutet, Stockholm, 171
76, Sweden
| | - G. Nilsson
- Karolinska Institutet, Stockholm, 171
76, Sweden
| | - G. Edman
- Tiohundra Hospital, SE-761
29, Norrtälje, Sweden
| | | |
Collapse
|
11
|
Domeij-Arverud E, Latifi A, Labruto F, Nilsson G, Ackermann PW. Can foot compression under a plaster cast prevent deep-vein thrombosis during lower limb immobilisation? Bone Joint J 2013; 95-B:1227-31. [PMID: 23997137 DOI: 10.1302/0301-620x.95b9.31162] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We hypothesised that adjuvant intermittent pneumatic compression (IPC) beneath a plaster cast would reduce the risk of deep-vein thrombosis (DVT) during post-operative immobilisation of the lower limb. Of 87 patients with acute tendo Achillis (TA) rupture, 26 were prospectively randomised post-operatively after open TA repair. The treatment group (n = 14) received two weeks of IPC of the foot for at least six hours daily under a plaster cast. The control group (n = 12) had no additional treatment. At two weeks post-operatively all patients received an orthosis until follow-up at six weeks. At two and six weeks the incidence of DVT was assessed using colour duplex sonography by two ultrasonographers blinded to the treatment. Two patients withdrew from the study due to inability to tolerate IPC treatment. An interim analysis demonstrated a high incidence of DVT in both the IPC group (9 of 12, 75%) and the controls (6 of 12, 50%) (p = 0.18). No significant differences in incidence were detected at two (p = 0.33) or six weeks (p = 0.08) post-operatively. Malfunction of the IPC leading to a second plaster cast was found to correlate with an increased DVT risk at two weeks (ϕ = 0.71; p = 0.019), leading to a premature abandonment of the study. We cannot recommend adjuvant treatment with foot IPC under a plaster cast for outpatient DVT prevention during post-operative immobilisation, owing to a high incidence of DVT related to malfunctioning of this type of IPC application.
Collapse
Affiliation(s)
- E Domeij-Arverud
- Institution of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
12
|
Vandy FC, Stabler C, Eliassen AM, Hawley AE, Guire KE, Myers DD, Henke PK, Wakefield TW. Soluble P-selectin for the diagnosis of lower extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2013; 1:117-1125. [PMID: 23998134 DOI: 10.1016/j.jvsv.2012.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Although duplex ultrasound is the standard for the diagnosis of lower extremity deep venous thrombosis (LE-DVT), imaging is not always available. The use of D-dimer can exclude (high-sensitivity), but not rule in (low-specificity) LE-DVT. Previously, we demonstrated that soluble P-selectin (sP-sel) in combination with the Wells score, establishes the diagnosis of LE-DVT with a specificity of 96% and a positive predictive value of 100%. In order to validate our previous results, we applied the model to a separate but similar patient cohort. Additionally, we analyzed the role of biomarkers for diagnosing upper extremity DVT (UE-DVT). METHODS Between April 2009 and March 2012, all patients presenting for a duplex ultrasound exam with concern of DVT were screened. Demographics, clinical data, D-dimer, sP-sel, C-reactive protein, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and von Willebrand factor levels were prospectively collected in 279 patients (234 LE-DVT, 45 UE-DVT). Continuous and categorical variables among patients with DVT were compared with patients without DVT. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were then calculated using our previously derived cut points to rule in or exclude DVT. RESULTS Among 234 patients evaluated for LE-DVT, 112 (48%) patients had a confirmed LE-DVT with significant differences in all biomarkers. When Wells score ≥2, sP-sel could rule in LE-DVT with a specificity of 97.5% and a positive predictive value of 91%, which was more accurate than Wells score ≥2 and D-dimer (specificity, 65%; positive predictive value, 69%). When Wells score was <2, D-dimer was superior to sP-sel for excluding the diagnosis of LE-DVT (sensitivity, 98%; negative predictive value, 95% vs sensitivity, 91%; negative predictive value, 79%). The use of additional biomarkers did not increase accuracy. Had imaging not been available, we could have correctly ruled in or ruled out LE-DVT in 29% (67/234) of patients. The use of sP-sel in UE-DVT was nondiagnostic. CONCLUSIONS We demonstrate that when Wells score ≥2, sP-sel is an excellent biomarker to rule in LE-DVT. Different from our previous study, D-dimer and a Wells score <2 was most sensitive at excluding a diagnosis of LE-DVT. Combined, Wells score, sP-sel, and D-dimer can both rule in and exclude LE-DVT in approximately one-third of patients.
Collapse
|
13
|
Watanabe H, Sekiya H, Kariya Y, Hoshino Y, Sugimoto H, Hayasaka S. The incidence of venous thromboembolism before and after total knee arthroplasty using 16-row multidetector computed tomography. J Arthroplasty 2011; 26:1488-93. [PMID: 21316910 DOI: 10.1016/j.arth.2011.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 01/04/2011] [Indexed: 02/01/2023] Open
Abstract
We performed a prospective study to determine the incidence of venous thromboembolism (VTE) using 16-row multidetector computed tomography (MDCT). The study included 71 patients who underwent total knee arthroplasty between September 2004 and March 2009. Multidetector computed tomography was performed 4 days before and after surgery. No patient had any presurgical symptoms of VTE. Presurgical and postsurgical incidences of pulmonary thromboembolism plus deep vein thrombosis were 0% and 13%, respectively; pulmonary thromboembolism alone, 1% and 3%, respectively; and deep vein thrombosis alone, 8% and 34%, respectively. Because asymptomatic VTE was noted in 9% of patients before surgery and 51% after surgery, we conclude that performing MDCT before and after total knee arthroplasty may be useful to clarify the incidence of VTE and to develop appropriate strategies for treatment and prevention.
Collapse
Affiliation(s)
- Hideaki Watanabe
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | | | | | | | | | | |
Collapse
|
14
|
de Perrot T, Righini M, Bounameaux H, Poletti PA. Contrast-enhanced sonographic diagnosis of unsuspected internal iliac vein thrombosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:553-555. [PMID: 21647919 DOI: 10.1002/jcu.20845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 04/01/2011] [Indexed: 05/30/2023]
Abstract
We report a rare case of an isolated and unsuspected thrombosis in the right internal iliac vein. The presentation was atypical with regard to the clinical manifestations and the thrombus location. The patient was admitted for an acute abdominal pain in the right iliac fossa. The thrombosis was suspected on the basis of a portal-phase contrast-enhanced abdominal CT but the lack of a delayed phase did not allow confirmation. Contrast-enhanced ultrasound confirmed the diagnosis, by displaying a well-defined filling defect.
Collapse
Affiliation(s)
- Thomas de Perrot
- Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | | | | | | |
Collapse
|
15
|
Crisp JG, Lovato LM, Jang TB. Compression Ultrasonography of the Lower Extremity With Portable Vascular Ultrasonography Can Accurately Detect Deep Venous Thrombosis in the Emergency Department. Ann Emerg Med 2010; 56:601-10. [DOI: 10.1016/j.annemergmed.2010.07.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 06/09/2010] [Accepted: 07/06/2010] [Indexed: 01/17/2023]
|
16
|
Martin MJ, Blair KS, Curry TK, Singh N. Vena Cava Filters: Current Concepts and Controversies for the Surgeon. Curr Probl Surg 2010; 47:524-618. [DOI: 10.1067/j.cpsurg.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
17
|
Utility of balanced steady-state free precession MR venography in the diagnosis of lower extremity deep venous thrombosis. AJR Am J Roentgenol 2010; 194:1357-64. [PMID: 20410426 DOI: 10.2214/ajr.09.3552] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the sensitivity and specificity of balanced steady-state free precession MR venography in the diagnosis of lower extremity deep venous thrombosis. SUBJECTS AND METHODS After undergoing lower extremity ultrasound because of suspicion of deep venous thrombosis, 64 patients were prospectively recruited to undergo balanced steady-state free precession MR venography with ultrasound as the reference standard. Ultrasound images were independently interpreted by two blinded ultrasound radiologists, and MR venograms were independently interpreted by two blinded MRI radiologists. The sensitivity, specificity, positive predictive value, and negative predictive value of MR venography were calculated for the diagnoses of all deep venous thrombosis, acute thrombi, and thrombosis of the popliteal, femoral, and common femoral veins individually. Proximal extent, thrombus age, ancillary findings, and interobserver agreement calculated with the Cohen kappa test were evaluated for ultrasound and MRI. The McNemar test was used to evaluate for statistical differences in diagnostic accuracy. RESULTS MR venography had a sensitivity of 94.7%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 97.7% for the diagnosis of all thrombi. For acute thrombi, the MR venography and ultrasound results were completely concordant. MR venography depicted greater proximal extent in five of 18 cases in which thrombosis was found. The MR venographic findings agreed completely with the ultrasound findings in determination of thrombus age. For both ultrasound and MR venography, interobserver agreement was 100% on a per-patient basis. No statistical difference was identified in the diagnostic performance of the two techniques. CONCLUSION Balanced steady-state free precession MR venography is highly accurate in the diagnosis of lower extremity deep venous thrombosis.
Collapse
|
18
|
Goel DP, Buckley R, deVries G, Abelseth G, Ni A, Gray R. Prophylaxis of deep-vein thrombosis in fractures below the knee: a prospective randomised controlled trial. ACTA ACUST UNITED AC 2009; 91:388-94. [PMID: 19258618 DOI: 10.1302/0301-620x.91b3.20820] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of deep-vein thrombosis and the need for thromboprophylaxis following isolated trauma below the knee is uncertain. We have investigated this with a prospective randomised double-blind controlled trial using low molecular weight heparin with saline injection as placebo in patients aged between 18 and 75 years who had sustained an isolated fracture below the knee which required operative fixation. All patients had surgery within 48 hours of injury and were randomised to receive either the placebo or low molecular weight heparin for 14 days, after which they underwent bilateral lower limb venography, interpreted by three independent radiologists. Further follow-up was undertaken at two, six, eight and 12 weeks. A total of 238 patients fulfilled all the inclusion criteria, with 127 in the low molecular weight heparin group and 111 in the placebo group, all of whom underwent bilateral venography. There was no statistically significant difference in the incidence of deep-vein thrombosis between those patients treated with low molecular weight heparin or the placebo (p = 0.22). The number of deep-vein thromboses in the two groups was 11 (8.7%) and 14 (12.6%), respectively. Age and the type of fracture were significantly associated with the rate of deep-vein thrombosis (p = 0.001 and p = 0.009, respectively) but gender, comorbidities and the body mass index were not. The overall incidence of deep-vein thrombosis in this series was 11%. There was no clinical or statistical significant reduction in the incidence of deep-vein thrombosis with the use of thromboprophylaxis. However, we accept that owing to a cessation of funding, recruitment to this trial had to be ended prior to establishing the necessary sample size. Our results cannot, therefore, categorically exclude the possibility that low molecular weight heparin treatment could be beneficial. We recommend a further multicentre trial be undertaken to resolve this matter.
Collapse
Affiliation(s)
- D P Goel
- Department of Orthopaedics, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | | | | | | | | | | |
Collapse
|
19
|
Lønnebakken MT, Gerdts E, Wirsching J, Pedersen OM. Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report. Cardiovasc Ultrasound 2009; 7:14. [PMID: 19323809 PMCID: PMC2667400 DOI: 10.1186/1476-7120-7-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022] Open
Abstract
Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.
Collapse
|
20
|
Doporučení pro duplexní ultrazvukové vyšetření končetinových žil. COR ET VASA 2009. [DOI: 10.33678/cor.2009.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
21
|
Pedrosa I, Ngo L, Wei J, Schuster M, Mahallati H, Smith M, Rofsky NM. Dynamic half-Fourier single-shot turbo spin echo for assessment of deep venous thrombosis: initial observations. Magn Reson Imaging 2008; 27:617-24. [PMID: 19106024 DOI: 10.1016/j.mri.2008.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 09/26/2008] [Accepted: 10/01/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to retrospectively analyze the value of dynamic half-Fourier single-shot turbo spin echo (HASTE) imaging in patients with suspected deep venous thrombosis (DVT). MATERIALS AND METHODS Fifty-five veins in 24 patients were interrogated using a HASTE sequence with the patients relaxed and in various degrees of Valsalva. Veins were analyzed for changes in caliber (+CAL) and signal intensity (+SI) or in their absence (-CAL and -SI, respectively) and compared with the presence of thrombus on gadolinium-enhanced magnetic resonance imaging. RESULTS There was no thrombus in veins with the +CAL, +SI pattern (n=40) (P<.01). Five of seven veins (71.4%) with the -CAL, -SI pattern had thrombus (P<.01). A qualitative change in CAL had a sensitivity of 100% and a specificity of 91% for the presence of thrombus. An increase of 1.5 mm in CAL had a sensitivity of 100% and a specificity of 93% for this diagnosis. CONCLUSION Dynamic HASTE imaging offers a physiological method to evaluate veins for deep venous thrombosis.
Collapse
Affiliation(s)
- Ivan Pedrosa
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Venous thromboembolic disease is composed of two disease entities: pulmonary thromboembolism/pulmonary embolism and deep venous thrombosis. Clinical signs and symptoms of venous thromboembolic disease often are nonspecific and, as a result, the diagnosis may be difficult. If left untreated, pulmonary embolism can lead to a potentially fatal outcome. This article focuses on CT angiography as the diagnostic modality for thromboembolic pulmonary embolism and briefly discusses nonthromboembolic pulmonary embolism.
Collapse
Affiliation(s)
- Wael E A Saad
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | | |
Collapse
|
23
|
Narayan RK, Maas AIR, Marshall LF, Servadei F, Skolnick BE, Tillinger MN. Recombinant factor VIIA in traumatic intracerebral hemorrhage: results of a dose-escalation clinical trial. Neurosurgery 2008; 62:776-86; discussion 786-8. [PMID: 18496183 DOI: 10.1227/01.neu.0000316898.78371.74] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Intracerebral hemorrhages, whether spontaneous or traumatic (tICH), often expand, and an association has been described between hemorrhage expansion and worse clinical outcomes. Recombinant factor VIIa (rFVIIa) is a hemostatic agent that has been shown to limit hemorrhage expansion and which, therefore, could potentially reduce morbidity and mortality in tICH. This first prospective, randomized, placebo-controlled, dose-escalation study evaluated the safety and preliminary effectiveness of rFVIIa to limit tICH progression. METHODS Patients were enrolled if they had tICH lesions of at least 2 ml on a baseline computed tomographic scan obtained within 6 hours of injury. rFVIIa or placebo was administered within 2.5 hours of the baseline computed tomographic scan but no later than 7 hours after injury. Computed tomographic scans were repeated at 24 and 72 hours. Five escalating dose tiers were evaluated (40, 80, 120, 160, and 200 microg/kg rFVIIa). Clinical evaluations and adverse events were recorded until Day 15. RESULTS No significant differences were detected in mortality rate or number and type of adverse events among treatment groups. Asymptomatic deep vein thrombosis, detected on routinely performed ultrasound at Day 3, was observed more frequently in the combined rFVIIa treatment group (placebo, 3%; rFVIIa, 8%; not significant). A nonsignificant trend for rFVIIa dose-response to limit tICH volume increase was observed (placebo, 21.0 ml; rFVIIa, 10.1 ml). CONCLUSION In this first prospective study of rFVIIa in tICH, there appeared to be less hematoma progression in rFVIIa-treated patients (80-200 microg/kg) compared with that seen in placebo treated patients. The potential significance of this biological effect on clinical outcomes and the significance of the somewhat higher incidence of ultrasound-detected deep vein thromboses in the rFVIIa-treated group need to be examined in a larger prospective randomized clinical trial.
Collapse
Affiliation(s)
- Raj K Narayan
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Abstract
Background
Deep vein thrombosis of the leg affects 1–2 per cent of the population with an annual incidence of 0·5–1 per 1000. It presents with non-specific symptoms and signs making clinical diagnosis difficult. Techniques to image and diagnose this condition are advancing rapidly.
Methods and results
A literature review from 1980 to 2007 was undertaken using PubMed, The Cochrane Library, Medline and Embase. The most frequently used diagnostic test is duplex ultrasonography which is accurate above the knee and has a low cost, but is limited by inaccuracy when assessing the pelvic and distal veins and in diagnosing a new thrombosis in the post-thrombotic limb. Magnetic resonance imaging (MRI) and sonographic elasticity imaging are more recent techniques that have shown promise in overcoming these limitations. However, their availability is currently restricted because they are expensive. Computed tomography (CT) is sensitive, specific and provides good imaging of the pelvis. It has the advantage that it can be performed at the same time as CT pulmonary angiography.
Conclusion
MRI has some specific advantages over duplex ultrasonography, but requires refinement before it can be used clinically. Venography or CT venography should be considered when duplex scanning is inadequate.
Collapse
Affiliation(s)
- J H Orbell
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - A Smith
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - K G Burnand
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| | - M Waltham
- King's College London, Academic Department of Surgery, Cardiovascular Division, St Thomas' Hospital, London, UK
| |
Collapse
|
25
|
Ghys T, Achtergael W, Verschraegen I, Leus B, Jochmans K. Diagnostic accuracy of the Triage® D-dimer test for exclusion of venous thromboembolism in outpatients. Thromb Res 2008; 121:735-41. [PMID: 17888501 DOI: 10.1016/j.thromres.2007.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/05/2007] [Accepted: 07/13/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated the diagnostic performance of the Triage D-dimer test, a new fast quantitative point-of-care whole blood D-dimer assay and compared it with the Vidas D-dimer assay. MATERIALS AND METHODS The study population comprised 319 outpatients for whom D-dimer testing was requested in order to rule out venous thromboembolism (VTE). Routine testing consisted of a plasma ELISA D-dimer analysis (Vidas). For all included patients, an additional EDTA whole blood D-dimer test (Triage) was performed. Patients were classified by reference imaging or by follow-up of the medical record. Accuracy indices, receiver operating characteristics and the kappa coefficient for agreement were calculated using the cutoff values recommended by the manufacturer. RESULTS Prevalence of VTE was 14%. Sensitivity and specificity for VTE were 98% (95%CI: 88-100) and 34% (95%CI: 28-40) for Vidas and 91% (95%CI: 78-97) and 42% (95%CI: 36-48) for Triage, respectively. The differences in sensitivity and specificity between both D-dimer assays were statistically significant (McNemar, p<0.0001). ROC-curve analysis yielded an area under the curve of 0.83 (95%CI: 0.76-0.89) for the Vidas and 0.81 (95%CI: 0.74-0.88) for the Triage (p=0.396). The kappa coefficient for agreement between Vidas and Triage was 0.75 (95%CI: 0.68-0.79). CONCLUSIONS The Triage and Vidas D-dimer tests show comparable diagnostic accuracy. Vidas showed a significant higher sensitivity. Our findings strongly suggest lowering the cutoff for the Triage D-dimer test from 400 to 350 ng/mL. In this way specificity lowers from 42 to 38%, but, more importantly, sensitivity increases from 91 to 95%.
Collapse
Affiliation(s)
- Timothy Ghys
- Department of Hematology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
26
|
Uno K, Homma S, Satoh T, Nakanishi K, Abe D, Matsumoto K, Oki A, Tsunoda H, Yamaguchi I, Nagasawa T, Yoshikawa H, Aonuma K. Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer. Br J Cancer 2007; 96:290-5. [PMID: 17211468 PMCID: PMC2359996 DOI: 10.1038/sj.bjc.6603552] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer, and clear cell carcinoma in particular, reportedly increases the risk of venous thromboembolism (VTE). However, the mechanisms remain unclear. Tissue factor (TF) supposedly represents a major factor in the procoagulant activities of cancer cells. The present study examined the involvement of TF expression in VTE for patients with ovarian cancer. Subjects comprised 32 consecutive patients (mean age 49.8 years) with histologically confirmed ovarian cancer. Presence of VTE was examined using a combination of clinical features, D-dimer levels and venous ultrasonography. Immunohistochemical analysis was used to evaluate TF expression into 4 degrees. Venous thromboembolism was identified in 10 of the 32 patients (31%), including five of the 11 patients with clear cell carcinoma. Tissue factor expression was detected in cancer tissues from 24 patients and displayed significant correlations with VTE development (P=0.0003), D-dimer concentration (P=0.003) and clear cell carcinoma (P<0.05). Multivariate analysis identified TF expression as an independent predictive factor of VTE development (P<0.05). Tissue factor (TF) expression is a possible determinant of VTE development in ovarian cancer. In particular, clear cell carcinoma may produce excessive levels of TF and is more likely to develop VTE.
Collapse
Affiliation(s)
- K Uno
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - S Homma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 305-8575 Japan. E-mail:
| | - T Satoh
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - K Nakanishi
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - D Abe
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - K Matsumoto
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - A Oki
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - H Tsunoda
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - I Yamaguchi
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - T Nagasawa
- Department of Clinical and Experimental Hematology, Major of Advanced Biomedical Applications, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - H Yoshikawa
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - K Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| |
Collapse
|
27
|
Yanase S, Matsumura Y, Nomura J, Sekida M, Nagai K, Nagata T, Inui M, Tagawa T. Relationship between magnetic resonance imaging and histopathologic findings in thrombosis in the oral and maxillofacial region: a case report. ACTA ACUST UNITED AC 2006; 103:e23-7. [PMID: 17178482 DOI: 10.1016/j.tripleo.2006.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 11/16/2022]
Abstract
Histopathologic changes are observed during the clinical course of thrombosis, and the evaluation of such changes by magnetic resonance imaging (MRI) might enhance the accuracy of qualitative diagnosis of the disease. The relationship between histopathologic and MRI findings in the chronic phase of deep venous thrombosis (DVT) that developed in the masseter muscle of a 50-year-old Japanese female patient is described. Two regions with different MRI signal intensities were identified, and a 3-layer structure was observed by microscopy. The distinct MRI regions correlated with the microscopic structure, suggesting that MRI can be used for qualitative imaging of a maxillofacial thrombus.
Collapse
Affiliation(s)
- Shigeaki Yanase
- Division of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
| | | | | | | | | | | | | | | |
Collapse
|