Download PDF
Thromb Haemost 2003; 89(02): 221-227
DOI: 10.1055/s-0037-1613435
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs

Antoine Elias
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Luc Mallard
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Marie Elias
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Catherine Alquier
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
François Guidolin
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Bruno Gauthier
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Alain Viard
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Pierre Mahouin
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Anne Vinel
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
,
Henri Boccalon
1   Department of Vascular Medicine, Centre Hospitalier Universitaire Rangueil, Toulouse; Clinic for Cardiology and Vascular Medicine, Clinique d’Occitanie, Muret; Internal Medicine, Centre Hospitalier Général, Foix; and Vascular Medicine , Clinique Sarrus, Teinturier, Toulouse, France
› Author Affiliations
Further Information

Publication History

Received 22 September 2002

Accepted after revision 01 November 2002

Publication Date:
07 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

In patients clinically suspected of deep-vein thrombosis (DVT) of the lower limbs, it is safe to withhold anticoagulant therapy after a negative ultrasound (US) limited to the popliteal and the femoral veins, provided that this can either be repeated or combined with other diagnostic procedures. To assess the safety of withholding anticoagulants after a single negative complete US, we performed a multicenter, prospective, cohort study including consecutive ambulatory outpatients from institutional and private practice settings, with a clinically suspected first episode of DVT. Patients fulfilling the inclusion criteria were enrolled after careful clinical assessment. A complete US examination of the proximal and the distal veins was performed according to a standardized and detailed protocol. Anticoagulant therapy was administered in patients with proximal or isolated distal DVT and withheld in those with negative results. The main outcome measure was the occurrence of objectively documented clinical thromboembolic events during a three-month follow-up after a negative US.

Out of 623 patients,401 (64.4%) had a baseline negative US, were not anticoagulated and could be followed-up for three months. Two patients presented a calf DVT within three months. The incidence of venous thromboembolic events, including distal DVT, was 0.5% [95% confidence interval: 0.1-1.8]. No proximal DVT, or non-fatal or fatal pulmonary embolism occurred (incidence: 0.0% [95% confidence interval: 0.0-0.9]).

In conclusion, it is safe to withhold anticoagulant therapy in patients with clinically suspected DVT after a single, negative, complete US. Integrating this method within diagnostic strategies for DVT could improve management and be more acceptable for patients and physicians.

Keywords

Ultrasonography - venous thrombosis - calf veins - prospective - cohort
 

  • References

  • 1 Elias A, Le Corff G, Bouvier JL, Benichou M, Serradimigni A. Value of real time B mode ultrasound imaging in the diagnosis of deep vein thrombosis of the lower limbs. Int Angiol 1987; 6 (02) 175-82.
    PubMedSearch in Google Scholar
  • 2 Lensing AW, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G. et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320 (06) 342-5.
    CrossrefPubMedSearch in Google Scholar
  • 3 Becker DM, Philbrick JT, Abbitt PL. Real-time ultrasonography for the diagnosis of lower extremity deep venous thrombosis. The wave of the future?. Arch Intern Med 1989; 149 (08) 1731-4.
    CrossrefPubMedSearch in Google Scholar
  • 4 Kearon C, Julian JA, Newman TE, Ginsberg JS.. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging. Practice Guidelines Initiative. Ann Intern Med 1998; 128 (08) 663-77.
    PubMedSearch in Google Scholar
  • 5 Habscheid W, Landwehr P. [Diagnosis of acute deep leg vein thrombosis with compression ultrasonography]. Ultraschall Med 1990; 11 (06) 268-73.
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Yucel EK, Fisher JS, Egglin TK, Geller SC, Waltman AC. Isolated calf venous thrombosis: diagnosis with compression US. Radiology 1991; 179 (02) 443-6.
    CrossrefPubMedSearch in Google Scholar
  • 7 Wichert C, Gmelin E, Jansen O, Marienhoff N. [Diagnosis of thrombophlebitis of the leg using duplex sonography]. Aktuelle Radiol 1993; 3 (01) 37-42.
    PubMedSearch in Google Scholar
  • 8 Bradley MJ, Spencer PA, Alexander L, Milner GR. Colour flow mapping in the diagnosis of the calf deep vein thrombosis. Clin Radiol 1993; 47 (06) 399-402.
    CrossrefPubMedSearch in Google Scholar
  • 9 Atri M, Herba MJ, Reinhold C, Leclerc J, Ye S, Illescas FF. et al. Accuracy of sonography in the evaluation of calf deep vein thrombosis in both postoperative surveillance and symptomatic patients. AJR Am J Roentgenol 1996; 166 (06) 1361-7.
    CrossrefPubMedSearch in Google Scholar
  • 10 Gottlieb RH, Widjaja J, Tian L, Rubens DJ, Voci SL. Calf sonography for detecting deep venous thrombosis in symptomatic patients: experience and review of the literature. J Clin Ultrasound 1999; 27 (08) 415-20.
    CrossrefPubMedSearch in Google Scholar
  • 11 Sluzewski M, Koopman MM, Schuur KH, van Vroonhoven TJ, Ruijs JH. Influence of negative ultrasound findings on the management of in- and outpatients with suspected deep-vein thrombosis. Eur J Radiol 1991; 13 (03) 174-7.
    CrossrefPubMedSearch in Google Scholar
  • 12 Heijboer H, Buller HR, Lensing AW, Turpie AG, Colly LP, ten Cate JW. A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients. N Engl J Med 1993; 329 (19) 1365-9.
    CrossrefPubMedSearch in Google Scholar
  • 13 Cogo A, Lensing AW, Koopman MM, Piovella F, Siragusa S, Wells PS. et al. Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 1998; 316 7124 17-20.
    CrossrefPubMedSearch in Google Scholar
  • 14 Birdwell BG, Raskob GE, Whitsett TL, Durica SS, Comp PC, George JN. et al. The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med 1998; 128 (01) 1-7.
    CrossrefPubMedSearch in Google Scholar
  • 15 Bernardi E, Prandoni P, Lensing AW, Agnelli G, Guazzaloca G, Scannapieco G. et al. D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study. The Multicentre Italian D-dimer Ultrasound Study Investigators Group. BMJ 1998; 317 7165 1037-40.
    CrossrefPubMedSearch in Google Scholar
  • 16 Perrier A, Desmarais S, Miron MJ, de Moer-loose P, Lepage R, Slosman D. et al. Noninvasive diagnosis of venous thrombo-embolism in out-patients. Lancet 1999; 353 9148 190-5.
    CrossrefPubMedSearch in Google Scholar
  • 17 Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C. et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet 1995; 345 8961 1326-30.
    CrossrefPubMedSearch in Google Scholar
  • 18 Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L. et al. Application of a diagnostic clinical model for the management of hospitalized patients with suspected deep-vein thrombosis. Thromb Haemost 1999; 81 (04) 493-7.
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L. et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350 9094 1795-8.
    CrossrefPubMedSearch in Google Scholar
  • 20 Elias A. [Role of Doppler echography in the diagnosis of venous thrombosis]. Arch Mal Coeur Vaiss 1991; 84 (Suppl. 11) Suppl 1669-78.
    PubMedSearch in Google Scholar
  • 21 Mattos MA, Melendres G, Sumner DS, Hood DB, Barkmeier LD, Hodgson KJ. et al. Prevalence and distribution of calf vein thrombosis in patients with symptomatic deep venous thrombosis: a color-flow duplex study. J Vasc Surg 1996; 24 (05) 738-44.
    CrossrefPubMedSearch in Google Scholar
  • 22 Cornuz J, Pearson SD, Polak JF. Deep venous thrombosis: complete lower extremity venous US evaluation in patients without known risk factors – outcome study. Radiology 1999; 211 (03) 637-41.
    CrossrefPubMedSearch in Google Scholar
  • 23 Wolf B, Nichols DM, Duncan JL. Safety of a single duplex scan to exclude deep venous thrombosis. Br J Surg 2000; 87 (11) 1525-8.
    CrossrefPubMedSearch in Google Scholar
  • 24 Schellong SM, Schwarz T, Pudollek T, Schmidt B, Schroeder HE. Complete compression ultrasound for the diagnosis of proximal and distal deep venous thrombosis – a retrospective outcome study. Vasa 2001; 30 (04) 253-7.
    CrossrefPubMedSearch in Google Scholar
  • 25 Birdwell BG, Raskob GE, Whitsett TL, Durica SS, Comp PC, George JN. et al. Predictive value of compression ultrasonography for deep vein thrombosis in symptomatic outpatients: clinical implications of the site of vein noncompressibility. Arch Intern Med 2000; 160 (03) 309-13.
    CrossrefPubMedSearch in Google Scholar
  • 26 Barrellier MT, Somon T, Speckel D, Fournier L, Denizet D. [Duplex ultrasonography in the diagnosis of deep vein thrombosis of the legs. Agreement between two operators]. J Mal Vasc 1992; 17 (03) 196-201.
    PubMedSearch in Google Scholar
  • 27 Somjen GM, Donlan J, Hurse J, Bartholomew J, Weir E, Johnston AH. et al. Duplex ultrasound examination of the acutely painful and swollen leg. Dermatol Surg 1996; 22 (04) 383-7.
    PubMedSearch in Google Scholar
  • 28 Kearon C, Ginsberg JS, Douketis J, Crowther M, Brill-Edwards P, Weitz JI. et al. Management of suspected deep venous thrombosis in outpatients by using clinical assessment and D-dimer testing. Ann Intern Med 2001; 135 (02) 108-11.
    CrossrefPubMedSearch in Google Scholar
  • 29 Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 1985; 2 8454 515-8.
    PubMedSearch in Google Scholar
  • 30 Astermark J, Bjorgell O, Linden E, Lethagen S, Nilsson P, Berntorp E. Low recurrence rate after deep calf-vein thrombosis with 6 weeks of oral anticoagulation. J Intern Med 1998; 244 (01) 79-82.
    CrossrefPubMedSearch in Google Scholar
  • 31 Hyers TM, Agnelli G, Hull RD, Morris TA, Samama M, Tapson V. et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001; 119 (Suppl. 01) Suppl 176S-193S.
    CrossrefPubMedSearch in Google Scholar