Venous Sonography for the Diagnosis of Asymptomatic Deep Vein Thrombosis in Patients With Cancer Undergoing Chemotherapy

Abstract

Objective. Early detection of asymptomatic deep vein thrombosis by venous sonography may identify patients who may benefit from anticoagulant therapy and thus may prevent morbidity and mortality associated with deep vein thrombosis. The aim of this study was to examine the prevalence of deep vein thrombosis by venous sonography in asymptomatic ambulatory patients with cancer undergoing chemotherapy and to evaluate the correlation between procoagulant activity and asymptomatic deep vein thrombosis. Methods. The study population included 62 patients (32 with lung cancer and 30 with lymphoma) receiving chemotherapy with an ambulatory performance status and without clinical evidence of deep vein thrombosis. Bilateral venous sonographic studies of the lower extremities were performed, covering the femoropopliteal venous system. The D‐dimer level and acquired activated protein C resistance were determined in the patients and in 30 healthy control subjects. Results. Sonographic evidence of deep vein thrombosis on the femoropopliteal axis was found in 0 (0%) of 62 patients (1‐sided 95% confidence interval, 0%–4.8%). Acquired activated protein C resistance prevalence and D‐dimer levels were increased in study patients compared with control subjects (34% versus 0%; P < .003; median, 0.72 versus 0.25 mg/L; P < .0001, respectively). Conclusions. Despite the procoagulant tendency, venous sonography did not detect asymptomatic deep vein thrombosis in patients with cancer undergoing chemotherapy. Thus, screening by venous sonography is not justified in this patient population.

Asymptomatic deep vein thrombosis in advanced cancer patients: The value of venous sonography

“…9,12 In a previous study conducted on ambulatory cancer patients asymptomatic for DVT, we found no thrombosis on USD examinations. 18 In the present study on nonambulatory cancer patients, we found 46% of patients positive for DVT when WHO performance status was 4% and 27.6% when performance status was 3, which is consistent with other studies showing that immobilization is a risk factor for DVT.…”

“…18,[20][21][22] USD, the worldwide accepted test for the diagnosis of lower extremity DVT, is highly accurate for symptomatic DVT, 23 although it has a moderate sensitivity as a screening test in high-risk asymptomatic patients, 7,24,25 mainly due to the high incidence of asymptomatic DVT in the distal veins. It has been described that 90% of asymptomatic DVT occur in the calf.…”

Mechanisms for acquired activated protein C resistance in cancer patients

“…Earlier results published by our group demonstrated the association of acquired APCR with thrombosis in cancer patients [1]. Moreover, acquired APCR was found to be common also in cancer patients without thrombosis [1,2]. The aim of this study was to investigate potential mechanisms underlying these findings.…”

Implementation of an electronic medical record tool for early detection of deep vein thrombosis in the ambulatory oncology setting

“…Current guidelines from the American Society of Clinical Oncology (ASCO) recommend utilizing a validated risk tool for formal risk assessment . Recent data have shown that high‐risk patients are at a heightened risk of VTE and screening such patients with compression ultrasonography may identify subclinical VTE . Since both screen‐detected and incidental VTEs are identified based on imaging rather than symptoms, therapeutic anticoagulation is likely to be beneficial in both settings, although the evidence to support this is primarily for incidental pulmonary embolism (PE) and not for incidental deep vein thrombosis (DVT).…”

“…7 Recent data have shown that high-risk patients are at a heightened risk of VTE and screening such patients with compression ultrasonography may identify subclinical VTE. 2,[8][9][10][11] Since both screen-detected and incidental VTEs are identified based on imaging rather than symptoms, therapeutic anticoagulation is likely to be beneficial in both settings, although the evidence to support this is primarily for incidental pulmonary embolism (PE) and not for incidental deep vein thrombosis (DVT). Current guidelines also recommend that a screen-detected ("incidental") VTE be treated the same as symptomatic VTE.…”