Deep vein thrombosis special scenario recurrence

Jump to navigation Jump to search
Siren.gif

Resident
Survival
Guide

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Deep Vein Thrombosis Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Deep vein thrombosis from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

Assessment of Clinical Probability and Risk Scores

Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Ultrasound

Venography

CT

MRI

Other Imaging Findings

Treatment

Treatment Approach

Medical Therapy

IVC Filter

Invasive Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT

Recurrence

Pregnancy

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis special scenario recurrence On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis special scenario recurrence

CDC on Deep vein thrombosis special scenario recurrence

Deep vein thrombosis special scenario recurrence in the news

Blogs on Deep vein thrombosis special scenario recurrence

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis special scenario recurrence

Overview

When recurrent deep vein thrombosis (DVT) is suspected, the initial test should be a compression ultrasound if a previous ultrasound is available for comparison. A highly-sensitive D-dimer is also a possible initial test. If the compression ultrasound results are abnormal but non-diagnostic (increase in residual venous diameter of < 4 but ≥ 2 mm), further testing with venography or CT venography may be indicated. Patients suspected to have a recurrent episode of DVT may benefit from thrombophilia evaluation.[1]

2012 VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)[1]

Venography in Patients With Suspected Recurrent DVT

Class I
"1. In patients suspected of having recurrent lower extremity DVT, we recommend initial evaluation with proximal CUS or a highly sensitive D-dimer over venography, CT venography, or MRI. (Level of Evidence: B) "
"2. If the highly sensitive D-dimer is positive, we recommend proximal CUS over venography, CT venography, or MRI. (Level of Evidence: B) "
"3. We recommend that patients with suspected recurrent lower extremity DVT and a negative highly sensitive D-dimer or negative proximal CUS and negative moderately or highly sensitive D-dimer or negative serial proximal CUS undergo no further testing for suspected recurrent DVT rather than venography. (Level of Evidence: B)"
"4. If CUS of the proximal veins is positive (new noncompressible segment in the common femoral or popliteal vein), we recommend treating for DVT and performing no further testing over performing confirmatory venography. (Level of Evidence: B)"
Class II
"1. In patients with suspected recurrent lower extremity DVT in whom initial proximal CUS is negative (normal or residual diameter increase of < 2 mm), we suggest at least one further proximal CUS (day 7 ± 1) or testing with a moderately or highly sensitive D-dimer (followed by repeat CUS [day 7 ± 1] if positive) rather than no further testing or venography. (Level of Evidence: B)"
"2. If CUS of the proximal veins is positive (≥ 4-mm increase in venous diameter during compression compared with that in the same venous segment on a previous result), we recommend treating for DVT and performing no further testing over performing confirmatory venography. (Level of Evidence: B)"

Compression Ultrasonography in Patients With Suspected Recurrent DVT

Class I
"1. In patients with suspected recurrent lower extremity DVT and abnormal but nondiagnostic US results (eg, an increase in residual venous diameter of < 4 but ≥ 2 mm), we recommend further testing with venography, if available. (Level of Evidence: B)"
Class II
"1. In patients with suspected recurrent lower extremity DVT and abnormal but nondiagnostic US results (eg, an increase in residual venous diameter of < 4 but ≥ 2 mm), we recommend further testing with serial proximal CUS (Level of Evidence: B) or testing with a moderately or highly sensitive D-dimer with serial proximal CUS as above if the test is positive (Level of Evidence: B), as opposed to other testing strategies or treatment."

Pretest Probability Assessment in Patients With Suspected Recurrent DVT

Class I
"1. In patients with suspected recurrent ipsilateral DVT and an abnormal US without a prior result for comparison, we recommend further testing with venography, if available. (Level of Evidence: B)"
Class II
"1. In patients with suspected recurrent ipsilateral DVT and an abnormal US without a prior result for comparison, we recommend further testing with a highly sensitive D-dimer (Level of Evidence: B) over serial proximal CUS. In patients with suspected recurrent ipsilateral DVT and an abnormal US without prior result for comparison and a negative highly sensitive D-dimer, we suggest no further testing over venography (Level of Evidence: C). In patients with suspected recurrent ipsilateral DVT and an abnormal US without prior result for comparison and a positive highly sensitive D-dimer, we suggest venography if available over empirical treatment of recurrence (Level of Evidence: C)."

References

  1. 1.0 1.1 Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; et al. (2012). "VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e691S–736S. doi:10.1378/chest.11-2300. PMC 3278054. PMID 22315276.

Template:WH Template:WS