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Updated: Aug 30, 2026

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
06:45

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Published on: February 10, 2023

Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery. A randomized

Benjamin Schmidt1, Ronny Michler, Martin Klein

  • 1Division of Angiology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. benj.schmidt@gmx.de

Thrombosis and Haemostasis
|November 5, 2003
PubMed

Insights

Ultrasound screening for deep vein thrombosis (DVT) after hip or knee replacement surgery did not lower the incidence of proximal DVT or pulmonary embolism. Prolonged prophylaxis with low molecular weight heparin (LMWH) showed a trend toward fewer events.

Area of Science:

  • Orthopedic Surgery
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Deep vein thrombosis (DVT) is a risk after orthopedic surgery.
  • Ultrasound screening detects thrombosis, but the benefit of screening for distal DVT is unclear.
  • Standard prophylaxis involves 10 days of low molecular weight heparin (LMWH).

Purpose of the Study:

  • To evaluate the clinical impact of ultrasound screening for proximal and distal DVT.
  • To compare prolonged LMWH prophylaxis versus ultrasound screening in patients undergoing hip or knee replacement.
  • To determine the cumulative rate of proximal DVT and symptomatic pulmonary embolism (PE).

Main Methods:

  • Randomized controlled trial involving 346 patients post-hip or knee replacement.
  • Patients received either prolonged LMWH prophylaxis or postoperative ultrasound screening.
  • All detected thrombosis was treated; screening-negative patients stopped heparin after 10 days.

Main Results:

  • Ultrasound detected distal DVT in 31.6% and proximal DVT in 5.1% of screened patients.
  • By day 35, the cumulative rate of proximal events was 8.7% in the screening group and 4.3% in the prolonged prophylaxis group (p=0.12).
  • No significant difference in proximal DVT or symptomatic PE rates between the groups.

Conclusions:

  • Ultrasound screening for DVT does not reduce the rate of proximal thrombosis or symptomatic PE after hip or knee replacement.
  • Prolonged LMWH prophylaxis may be more effective in preventing these events.
  • Current screening protocols may not be clinically impactful for preventing major thrombotic events.

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