Real-Time Ultrasound for Diagnosis of Symptomatic Venous Thrombosis and for Screening of Patients at Risk: Correlation with Ascending Conventional Venography

Monreal, Manuel; Montserrat, Enric; Salvador, Rafael; Bechini, Jordi; Donoso, L; MaCallejas, Jose; Foz, Màrius

doi:10.1177/000331978904000603

Cited by 65 publications

(24 citation statements)

References 21 publications

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“…Real-time Bmode ultrasound scanning was performed using a com mercially available scanner with a 7.5-MHz sector imaging transducer, as previously reported elsewhere [16]. PE was considered in patients with clinical symp toms, high-probability defects on ventilation-perfusion lung scan, and documentation of venous thrombosis of the lower extremities.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Platelet Count and the Risk of Bleeding in Hospitalized Patients with Venous Thromboembolism Starting Anticoagulant Therapy

Monréal

Urrutia²,

Martí³

et al. 1997

Pathophysiol Haemos Thromb

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In a series of patients with pulmonary embolism (PE) we have previously demonstrated that the risk of recurrent PE was inversely correlated to platelet count (PIC) levels. To find out whether PIC levels were also associated to a different incidence of heparin-related bleeding complications, we report our experience with 1,103 consecutive patients with venous thromboembolism (VTE) receiving full-dose heparin therapy. Six points of clinical and laboratory information were recorded on admission and then compared to the development of bleeding: the patient’s age and sex; the etiology of VTE; the type of heparin used (unfractioned, UFH, vs. low-molecular-weight, LMWH), the presence or lack of PE findings on lung scan, and the PIC levels on admission. Bleeding occurred in 64/1,103 patients (6%). Patients who bled were significantly older than those who did not (72 ± 11 vs. 64 ± 17 years; p = 0.0005). There were no significant differences in bleeding rate according to any of the risk factors that could have predisposed to VTE, but patients treated with UFH bled significantly more frequently than those on LMWH (48/636 vs. 16/467; odds ratio: 2.30; 95% confidence interval: 1.25-4.28). Finally, mean PIC levels were significantly lower at VTE diagnosis in patients who subsequently bled (227 ± 112 vs. 262 ± 110 × 10⁹ liters^-1; p = 0.01). The logistic regression analysis confirmed that all three variables were independent risk factors for bleeding complications. This is the first study to demonstrate that PIC levels (within the normal range) are inversely correlated with the risk of heparin-related bleeding. These findings may be of interest not only from the point of view of pathogenesis but also clinically, as they may be used in the decision as to which VTE patients could receive heparin therapy at home.

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Section: Diagnostic Methodsmentioning

confidence: 99%

Platelet Count and the Risk of Bleeding in Hospitalized Patients with Venous Thromboembolism Starting Anticoagulant Therapy

Monréal

Urrutia²,

Martí³

et al. 1997

Pathophysiol Haemos Thromb

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“…9, [46][47][48][49] Numerous investigators have confirmed that CUS is nearly 100% sensitive and specific for the diagnosis of proximal DVT. 47,[49][50][51][52] Although CUS fails to adequately identify calf thrombi (<50 % sensitivity) 49,53,54 , only 20% to 30% of calf thrombi extend proximally and these are rarely asymptomatic. 12 Follow-up studies performed 7 days after an initially negative CUS have identified only 1% 51 to 1.4% 52 of patients with the subsequent development of DVT.…”

Section: I a G N O S T I C M O D A L I T I E Smentioning

confidence: 99%

Diagnosis of deep vein thrombosis and pulmonary embolism

Baker

2000

Compr Ther

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The diagnostic evaluation of the patient with suspected deep vein thrombosis (DVT) and pulmonary embolism (PE) is rapidly changing as the result of clinical studies that clarify the relationship between clinical features and the results of laboratory and imaging studies. The history and physical examination determine a clinical probability, which guides test selection and interpretation. Newly available diagnostic modalities allow greater diagnostic accuracy, lower cost, and greater convenience. New algorithms combine clinical features, the rapid ELISA (VIDAS) D-Dimer assay, compression ultrasonography, the ventilation/perfusion lung scan and spiral computed tomographic imaging.Morbidity and mortality studies indicate that 73% of PE diagnosed at autopsy were not detected clinically 1 and that PE has a mortality rate of 18% to 30% without treatment. 2 Over 90% of PE arise from DVT, and as many as 50% of patients with leg symptoms are proven to have a diagnosis other than DVT. 3-6 Classic symptoms for PE, such as pleuritic chest pain and hemoptysis, are not particularly useful in establishing the diagnosis of PE. 2 Clinical features alone are inadequate.Although often viewed as distinct clinical entities, DVT and PE represent manifestations of a continuum of disease. Over 50% of cases 7 of PE may not have recognized sources of DVT. Many patients with proximal DVT have clinically silent PE. Symptomatic thrombi are usually found in proximal veins 8,9 ; however, at least 50% of PE occurs in asymptomatic patients. 10 While the majority of DVT occurs in infrapopliteal veins, the primary source of PE is proximal DVT. 3,11-12 Calf DVT propagates proximally in about 20% to 30% of cases. 12 Predisposition to venous thromboembolic disease results from specific clinical conditions and hereditary and acquired blood defects. [13][14][15][16][17] High clinical probability occurs in malignancy, stasis, the postop-Traditional approaches to diagnosis of deep vein thrombosis and pulmonary embolism are primarily based on the results of compression ultrasonography and the ventilation/perfusion lung scan (V/Q). Spiral computed tomographic imaging may replace the V/Q scan, and the D-Dimer assay may guide evaluation.

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“…Sensitivity ranges from 89% to 100% while specificity ranges from 86% to 100%. 2,8,14,21,24,27 Other methods of examining accuracy of compression ultrasound for DVT have been examined. Two large prospective trials have investigated this question using follow up ultrasound examinations.…”

Section: Duplex Ultrasound Evaluation Of Symptomatic Acute Dvtmentioning

confidence: 99%