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Loffredo L, Vidili G, Sciacqua A, Cogliati C, Di Giulio R, Bernardini S, Ciacci P, Pietrangelo A, Orlando F, Paraninfi A, Boddi M, Di Minno G, Falsetti L, Lodigiani C, Santoliquido A, Ettorre E, Pignatelli P, Arezzo MF, Gutu E, Harenberg J, Violi F. Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications. Thromb J 2022; 20:72. [PMID: 36451162 PMCID: PMC9709753 DOI: 10.1186/s12959-022-00433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. OBJECTIVES To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. PATIENTS/METHODS In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. RESULTS Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. CONCLUSIONS We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. TRIAL REGISTRATION NCT03157843.
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Affiliation(s)
- Lorenzo Loffredo
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianpaolo Vidili
- grid.11450.310000 0001 2097 9138Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Chiara Cogliati
- grid.4708.b0000 0004 1757 2822 Department of Biomedical and Clinical Sciences, L.Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Rosella Di Giulio
- grid.416290.80000 0004 1759 7093Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Sciaila Bernardini
- grid.415207.50000 0004 1760 3756Department of Internal Medicine, AUSL Della Romagna, S. Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Paolo Ciacci
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonello Pietrangelo
- grid.413363.00000 0004 1769 5275Department of Internal Medicine 2, University Hospital of Modena, Modena, Italy
| | - Federica Orlando
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Aurora Paraninfi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Boddi
- grid.8404.80000 0004 1757 2304Experimental and Clinical Department, University of Florence, Florence, Italy
| | - Giovanni Di Minno
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lorenzo Falsetti
- grid.415845.9Internal and Sub-Intensive Medicine Department, A.O.U. “Ospedali Riuniti”, Ancona, Italy
| | - Corrado Lodigiani
- grid.417728.f0000 0004 1756 8807Cardiovascular Department, Thrombosis and Hemorrhagic Diseases Center, Humanitas Research Hospital, Rozzano, Milan Italy
| | - Angelo Santoliquido
- grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart, Rome, Italy
| | - Evaristo Ettorre
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Pasquale Pignatelli
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Felice Arezzo
- grid.7841.aDepartment of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Via del Castro Laurenziano, 9, 00161 Rome, Italy
| | - Evghenii Gutu
- grid.28224.3e0000 0004 0401 27383Rd Department of General Surgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Chisinau, Republic of Moldova
| | - Job Harenberg
- grid.7700.00000 0001 2190 4373Ruprecht-Kalrs University Heidelberg, Heidelberg, Germany
| | - Francesco Violi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Čečatka S, Klambauer K, Clevert DA. [ Compression ultrasound for suspected thrombosis]. MMW Fortschr Med 2022; 164:60-70. [PMID: 36310284 DOI: 10.1007/s15006-022-1992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Saša Čečatka
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Klinikum der Universität München-Grosshadern, Marchioninistraße 15, 81377, München, Deutschland.
| | - Konstantin Klambauer
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München-Grosshadern, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland
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Heller T, Becher M, Kröger JC, Beller E, Heller S, Höft R, Weber MA, Meinel FG. Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics. BMC Emerg Med 2021; 21:126. [PMID: 34717549 PMCID: PMC8557054 DOI: 10.1186/s12873-021-00516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background It remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT. Materials and methods In this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients’ electronic charts. Results DVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT. Conclusions Isolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.
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Affiliation(s)
- Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Mattes Becher
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Jens-Christian Kröger
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Susanne Heller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Raimund Höft
- Department of Emergency Medicine, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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Di Vilio A, Vergara A, Desiderio A, Iodice F, Serio A, Palermi S, Gambardella F, Sperlongano S, Gioia R, Acitorio M, D'Andrea A. Incremental value of compression ultrasound sonography in the emergency department. World J Crit Care Med 2021; 10:194-203. [PMID: 34616656 PMCID: PMC8462022 DOI: 10.5492/wjccm.v10.i5.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.
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Affiliation(s)
- Alessandro Di Vilio
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Andrea Vergara
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alfonso Desiderio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Franco Iodice
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alessandro Serio
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Stefano Palermi
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Francesco Gambardella
- Human Anatomy and Sport Medicine Division, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Simona Sperlongano
- Unit of Cardiology and Intensive Coronary Care, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Renato Gioia
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno 84084, Italy
| | - Maria Acitorio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore 84014, Italy
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Beller E, Becher M, Meinel FG, Kröger JC, Rajagopal R, Höft R, Weber MA, Heller T. Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis. BMC Med Imaging 2020; 20:127. [PMID: 33267839 PMCID: PMC7709303 DOI: 10.1186/s12880-020-00527-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symptoms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound. Methods We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information. Results Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explaining leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154). Conclusions Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT.
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Affiliation(s)
- Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Mattes Becher
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Jens-Christian Kröger
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | | | - Raimund Höft
- Department of Emergency Medicine, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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Roberts L, Rozen T, Murphy D, Lawler A, Fitzgerald M, Gibbs H, Brooks K, Ihle JF, Leong T, Orosz J, Paul E, Nanjayya VB. A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study). Ann Intensive Care 2020; 10:122. [PMID: 32926245 DOI: 10.1186/s13613-020-00739-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.
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Dehbozorgi A, Damghani F, Mousavi-Roknabadi RS, Sharifi M, Sajjadi SM, Hosseini-Marvast SR. Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department. J Res Med Sci 2019; 24:80. [PMID: 31620179 PMCID: PMC6788177 DOI: 10.4103/jrms.jrms_1057_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 06/03/2019] [Indexed: 11/08/2022]
Abstract
Background: This study aimed to assess the accuracy of three-point compression ultrasonography (3PCUS) performed for the diagnosis of proximal deep-vein thrombosis (DVT) in Emergency Department (ED) compared with the results of duplex US (DUS) (whole-leg compression ultrasound). Materials and Methods: The current prospective cross-sectional study with diagnostic test assessment was conducted on adult patients who were referred to the ED of a general teaching hospital in Shiraz, southern part of Iran (September 2016–May 2017), suspected of lower-extremity DVT, using a convenience sampling. The results of 3PCUS performed by ED residents were compared with the results of DUS performed by the radiology residents, which was considered as a criterion standard. Results: A total of 240 patients were enrolled, with a mean (standard deviation) age of 59.46 (16.58). 3PCUS has a sensitivity and a specificity of 100% (95% confidence interval [CI], 96.55%–100%) and 93.33% (95% CI, 87.72%–96.91%), respectively, in comparison with DUS (whole-leg compression ultrasound). Negative predictive value and positive predictive value were 100% and 92.11% (95% CI, 86.12%–95.64%), respectively, with an accuracy of 96.25% (95% CI, 93%–98.27%). Conclusion: The results of this study showed that 3PCUS of the lower extremities with a portable US machine, performed by the ED's residents, can accurately identify the presence or absence of lower-extremity DVT.
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Affiliation(s)
- Afsaneh Dehbozorgi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Damghani
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehrdad Sharifi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mahmoudreza Sajjadi
- Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower limb DVT in ultrasound series and is therefore a frequent medical condition. Unlike proximal DVT and pulmonary embolism (PE), which have been extensively studied and for which management is well standardized, much less is known on the optimal management of isolated calf DVT. Recent data arising from registries and non-randomized studies suggest that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated. This data had some impact on the international recommendations which recently stated that ultrasound surveillance instead of systematic therapeutic anticoagulation might be an option for selected low-risk patients. However, robust data arising from randomized studies are scarce. Indeed, only five randomized trials assessing the need for anticoagulation for calf DVT have been published. Many of these trials had an open-label design and were affected by methodological limitations. The only randomized placebo-controlled trial included low-risk patients (outpatients without cancer or previous venous thromboembolic events (VTE)) and was hampered by a limited statistical power. Nevertheless, data from this trial tend to confirm that the use of therapeutic anticoagulation in low-risk patients with symptomatic calf DVT is not superior to placebo in reducing VTE, but is associated with a significantly higher risk of bleeding. Further randomized studies are needed to define the best therapy for high-risk patients (inpatients, patients with active cancer or previous VTE), and the optimal dose and duration of treatment.
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Affiliation(s)
- Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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