Diagnostic tests and strategies in venous thromboembolism

Abstract

Venous thromboembolism (VTE) is a term including deep vein thrombosis (DVT) and pulmonary embolism (PE). Timely and accurate diagnosis of both is essential as delayed or missed diagnoses can result in death or longer term complications. Patients with suspected DVT should initially undergo a pretest probability Wells score. Depending on pretest probability Wells score they should then either proceed to two-point ultrasound scanning or D-dimer testing. Likewise, patients suspected of PE should undergo a two-level PE Wells score, and, if scored likely, a computed tomography pulmonary angiogram (CTPA), or, if there is a low pretest probability score, D-dimer testing. If positive, patients should undergo CTPA. Ventilation perfusion scanning (V/Q scan) or V/Q SPECT should be considered in place of CTPA if there is allergy to contrast media or renal impairment.

STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis

“…The lowest levels of agreement were found for items related to physical examination for local symptoms in the affected limb (e.g., presence of swelling, changes in skin temperature, skin discoloration) and worsening limb pain. The low levels of agreement for these local signs and symptoms confirm previous work that has found that clinical assessment for possible DVT (particularly in the early stages) is highly subjective and even well‐trained clinicians may miss early clinical signs (Falck‐Ytter et al., ; Songwathana et al., ; Strijkers et al., ; Tan et al., ; Tenna et al., ).…”

“…Homan's sign (pain in the calf when there is dorsiflexion of the foot) is no longer routinely used as a diagnostic tool for DVT due to its lack of sensitivity and specificity (Bacon, ). The reasons for the poor prognostic value of clinical signs are that each patient may present differently depending on site and size of thrombus and that the clotting process can also mimic many other disease states (Hotoleanu, Fodor, & Suciu, ; Strijkers, Cate‐Hoek, Bukkems, & Wittens, ; Tan, Van Rooden, Westerbeek, & Huisman, ; Tenna, Kappadath, & Stansby, ). Assessing postoperative orthopaedic patients also poses its own unique challenges, particularly as the surgical procedure also contributes to swelling and oedema in the affected limb (Schiff et al., ).…”

Systemic levels of the endothelium-derived soluble adhesion molecules endocan and E-selectin in patients with suspected deep vein thrombosis

“…The diagnosis of DVT is usually based on a careful clinical evaluation, D-dimer levels and visualization of the thrombosis (Goodacre et al 2006 ; Tenna et al 2012 ). In our present study all patients were initially evaluated with clinical examination, D-dimer and ultrasound examination; venography was performed only if DVT was still suspected but not visualized after this initial examination.…”

Diagnostic accuracy of deep vein thrombosis is increased by analysis using combined optimal cut-off values of postoperative plasma D-dimer levels

“…To date, lower limb phlebography has been considered to be the gold standard for the diagnosis of DVT; however, as it is an invasive and high-cost procedure, the application of lower limb phlebography in the diagnosis of liver DVT is limited (10). Color and spectral Doppler ultrasonography is commonly used in the diagnosis of DVT in lower limb veins; however, ultrasonography requires that patients move continually, which can increase patient suffering and is a time-consuming process.…”