Duplex follow-up of patients with DVT: does it have clinical significance?

Venous duplex ultrasonography is now the diagnostic test of choice for the diagnosis of deep venous thrombosis (DVT) at many institutions. In the research setting, the ability to serially evaluate thrombi localized to specific venous segments has shown the importance of recurrent thrombotic events and recanalization in the natural history of acute DVT. In addition, its availability and noninvasive nature have led increasingly to the use of serial venous ultrasound examinations in the clinical management of acute DVT. Unfortunately, there is little evidence to support the use of follow-up ultrasonography for many of these purposes. Based on the limited evidence available, follow-up ultrasound examinations appear to be warranted only in patients with isolated calf vein thrombosis and contraindications to conventional anticoagulation, patients with recurrent symptoms, and to establish a baseline after completion of therapy in patients at risk for recurrence. In contrast, the anticoagulant management of acute DVT should be guided by the results of clinical trials, and currently available evidence provides no basis for using ultrasonography to guide the duration of anticoagulation. Therefore, if therapy is based on guidelines derived from clinical trials, there are few indications for the noninvasive follow-up of DVT during anticoagulant treatment in the absence of new symptoms.