Deep vein thrombosis diagnostic approach
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]; Kashish Goel, M.D.
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Overview
A number of invasive (venography) and non-invasive tests are possible (impedance plethysmography, compression ultrasonography, D-dimer testing) for diagnosis. Compression ultrasonography is the noninvasive diagnosis of choice for patients with a first episode of suspected DVT.
In a patient population with a high prevalence of venous thromboembolism, a negative D-dimer assay may be insufficient to rule out DVT as a single test , and moreover not all D-dimer assays are validated for this. However, a D-dimer level <500 ng/mL by ELISA along with a low clinical probability (Wells score) or other negative non-invasive tests may be useful in excluding DVT, without doing ultrasound.
In patients with a first episode of DVT, a positive noninvasive study usually confirms the diagnosis. Compression ultrasonography has a positive predictive value of 94 percent (95% CI: 87-98 percent). In situation where the initial investigation was negative but the clinical suspicion of DVT is high, a repeat study should be done within a week. Complete lower extremity ultrasonography may eliminate the need for repeat testing, but a positive compression ultrasonography demands user expertise, and requires specialized instrumentation. The algorithm below presents a possible diagnostic approach.
CUS stands for Compression Ultrasonography; D-dimer is the highly sensitive assay.
Adapted from ACCP guidelines[1].
References
- ↑ Bates SM, Jaeschke R, Stevens SM; et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–418S. doi:10.1378/chest.11-2299. PMID 22315267. Unknown parameter
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