Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound

Johnson, Stacy A.; Stevens, Scott M.; Woller, Scott C.; Lake, Erica; Donadini, Marco Paolo; Cheng, Ji; Labarère, José; Douketis, James D.

doi:10.1001/jama.2010.43

Cited by 186 publications

(138 citation statements)

References 35 publications

Supporting

Mentioning

123

Contrasting

Unclassified

Order By: Relevance

“…Proximal DVT and distal DVT were defined as occurring above the knee and below the knee, respectively 13. Central venous catheter‐related thrombosis was defined according to whether a catheter had been present in the same or a contiguous venous segment within 72 h prior to the diagnosis 14.…”

Section: Methodsmentioning

confidence: 99%

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

View full text Add to dashboard Cite

AimVenous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.MethodsWe examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.ResultsThe study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL.ConclusionsAt least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.

show abstract

Section: Methodsmentioning

confidence: 99%

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

View full text Add to dashboard Cite

show abstract

“…20 A negative ultrasonography result alone is insufficient to exclude the diagnosis of a DVT, therefore, a D-dimer level assessment is also recommended. 21 D-dimer is a small protein fibrin degradation fragment detectable in the blood after a blood clot is degraded by fibrinolysis. The D-dimer level correlates with the size of the thrombus and clot activity.…”

Section: Diagnosismentioning

confidence: 99%

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

Marchand

Boucher

O’Shaughnessy

2015

Journal of Chiropractic Medicine

View full text Add to dashboard Cite

Objective: The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT). Clinical Features: An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered. Intervention and Outcomes: Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter. Conclusion: Although DVTs are common in the general population, presence in low-risk individuals may be overlooked. In the presence of subtle initial clinical signs such as those described in this case report, clinicians should keep a high index of suspicion for a DVT.Rapid identification of such clinical signs in association with a lack of objective examination findings warrants further evaluation due to potentially negative outcomes.

show abstract

“…A meta -analysis reported the sensitivity for detecting isolated calf DVT to be 73% (Kearon et al, 1998). Anticoagulation of calf DVT (that might spontaneously resolve) may unnecessarily place patients at increased risk of potential side effects of such medication, with an estimated 1.1% risk of major bleeding (Krakow & Ortel, 2005, as cited in Johnson et al, 2010). This particularly applies to frailer patients vulnerable to intra -cerebral haemorrhage from even innocuous trauma.…”

Section: Radiological Imaging and Intervention In Venous Thrombosismentioning

confidence: 99%

“…Venous Thrombi are dynamic structures, especially within the first 1 to 2 weeks after their onset (O'shaughnessy & Fitzgerald, 2000a(O'shaughnessy & Fitzgerald, , 2000b. Up to 25% of calf DVTs may propagate into the proximal veins (Johnson et al, 2010). Therefore, it is routine practice to repeat a negative scan after 5 to 7 days to assess for propagation into the proximal vasculature, particularly in patients with high pre-test probability scores.…”

Section: Radiological Imaging and Intervention In Venous Thrombosismentioning

confidence: 99%

Radiological Imaging and Intervention in Venous Thrombosis

Christie¹,

Roditi²,

Ananthakrishnan³

et al. 2012

Deep Vein Thrombosis

View full text Add to dashboard Cite

Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound

Abstract: Withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk of venous thromboembolism during 3-month follow-up.

Cited by 186 publications

References 35 publications

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

Radiological Imaging and Intervention in Venous Thrombosis

Contact Info

Product

Resources

About