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Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis:
A Cogo1, A W Lensing, M M Koopman
1Istituto di Semeiotica Medica, University of Padua, Italy.
Insights
Withholding anticoagulant treatment is safe for patients with suspected deep vein thrombosis (DVT) if initial compression ultrasonography is normal. Follow-up testing confirms low risk of venous thromboembolic complications.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Clinical Thrombosis
Background:
- Deep vein thrombosis (DVT) diagnosis often involves anticoagulant therapy.
- Compression ultrasonography is a key diagnostic tool for DVT.
- Assessing the safety of withholding anticoagulation in specific DVT suspicion scenarios is crucial for patient management.
Purpose of the Study:
- To evaluate the safety of withholding anticoagulant treatment in patients with clinically suspected deep vein thrombosis (DVT) who present with normal compression ultrasonography findings.
- To determine the incidence of venous thromboembolic complications in this patient group.
Main Methods:
- A prospective study involving 1702 patients with clinically suspected DVT.
- Simplified compression ultrasonography focused on the common femoral and popliteal veins.
- Patients with normal initial results underwent repeat ultrasonography 1 week later.
- Follow-up for venous thromboembolic complications over 6 months.
Main Results:
- The prevalence of DVT was 24% based on initial or repeat ultrasonography.
- None of the patients were lost to follow-up.
- A low cumulative rate of venous thromboembolic complications of 0.7% was observed over 6 months.
- Minimal additional healthcare resource utilization was noted.
Conclusions:
- Withholding anticoagulant treatment is safe for patients with clinically suspected DVT and normal compression ultrasonography results at presentation and 1-week follow-up.
- This approach minimizes unnecessary anticoagulation and associated risks.
- Serial ultrasonography provides a reliable method for safely managing suspected DVT cases with initially negative imaging.
Objective:
To evaluate the safety of withholding anticoagulant treatment from patients with clinically suspected deep vein thrombosis but normal findings on compression ultrasonography.
Design:
Compression ultrasonography was done with a simplified diagnostic procedure limited to the common femoral vein in the groin and the popliteal vein extending down to the trifurcation of the calf veins. Patients with normal ultrasonography findings at presentation were retested 1 week later.
Main Outcome Measure:
The incidence of venous thromboembolic complications during follow up for 6 months in patients in whom anticoagulant treatment was withheld on the basis of normal results on two ultrasonography tests 1 week apart.
Setting:
University research centres in four hospitals.
Results:
A total of 1702 patients were included in the study. Abnormal results on compression ultrasonography at presentation or at 1 week were found in 400 and 12 patients, respectively, for a prevalence of deep vein thrombosis of 24%. None of the patients were lost to follow up. Venous thromboembolic complications during the week of serial testing occurred in a single patient and in eight patients during 6 months' follow up, resulting in a cumulative rate of venous thromboembolic complications of 0.7% (95% confidence interval 0.3% to 1.2%). The mean number of extra hospital visits and additional tests required per initially referred patient was 0.8.
Conclusion:
It is safe to withhold anticoagulant treatment from patients with clinically suspected deep vein thrombosis who have a normal result on compression ultrasonography at the time of presentation and at 1 week.