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DOI: 10.1055/s-0038-1648508
Value of Liquid Crystal Contact Thermography and Plasma Level of D-Dimer for Screening of Deep Venous Thrombosis Following General Abdominal Surgery
Publikationsverlauf
Received 25. Oktober 1991
Accepted after revision 20. Dezember 1991
Publikationsdatum:
03. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199206/lookinside/thumbnails/10-1055-s-0038-1648508-1.jpg)
Summary
Because the use of radioactive fibrinogen uptake test (FUT) has become questionable both for ethical (risk of virus transmission) and technical (lack of sensitivity) reasons, we investigated the potential value of two alternative methods for screening of asymptomatic deep venous thrombosis following elective digestive surgery: liquid crystal contact thermography (LCCT) and measurement of plasma concentration of D-dimer (DD), as compared with bilateral ascending phlebography. Out of 194 patients, 185 underwent phlebography on the 8th (0-19, median and range) postoperative day. Despite prophylaxis with low-molecular-weight heparin and elastic stockings, DVT was detected on phlebography in 58 legs of 45 patients. Sensitivity of LCCT with respect to the presence of DVT was 55% (n = 184 patients) or 28% (n = 368 legs) with a specificity of 67% and 82%, respectively. These poor performances were obtained despite a good interobserver agreement for the LCCT assessments (overall kappa coefficient of 0.66 between three experts). The most accurate cut-off of DD for discriminating patients with or without DVT was 3,000 pg/1, as determined by ROC curve analysis. Sensitivity of a DD level of more than 3,000 pg/1 for the presence of phlebographically documented DVT on the 8th postoperative day was 89% for a specificity of 48%.
Thus, LCCT cannot be used for screening of postoperative, mainly asymptomatic DVT following general surgery. On the other hand, measurement of plasma DD may be useful for initial screening, a negative result (level less than 3,000 pg/1) allowing to exclude DVT (negative predictive value of 93%) and a positive result (positive predictive value of 35%) requiring confirmation by phlebography. This sequential approach might be useful in studies of the efficacy of antithrombotic regimens for prophylaxis of DVT in patients at risk.
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References
- 1 Biiller HR, Lensing AWA, Hirsh J, ten Cate JW. Deep vein thrombosis: new non-invasive diagnostic tests. Thromb Haemostas 1991; 66: 133-137
- 2 Kakkar W. Fibrinogen uptake test for detection of deep vein thrombosis. A review of current practice. Semin Nucl Med 1977; 7: 229-244
- 3 Fauno P, Suomalainen O, Bergqvist D, Fredin H, Kettunen K, Soimakallio S, Cederholm C, Karjalainen P, Vissinger H, Justesen T. The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture. Thromb Res 1990; 60: 185-190
- 4 Cruickshank MK, Levine MN, Hirsh J, Turpie AGG, Powers P, Jay R, Gent M. An evaluation of impedance plethysmography and 125I-Fibrinogen leg scanning in patients following hip surgery. Thromb Haemostas 1989; 62: 830-834
- 5 Pochaczevsky R, Pillari G, Feldman F. Liquid crystal contact thermography of deep venous thrombosis. AJR 1982; 138: 717-723
- 6 Nieuwenhuizen W. Plasma assays for derivatives of fibrin and of fibrinogen, based on monoclonal antibodies. Fibrinolysis 1988; 2: 1-5
- 7 Jensen C, Lomholdt Knudsen L, Hegedtis V. The role of contact thermography in the diagnosis of deep venous thrombosis. Eur J Radiol 1983; 3: 99-102
- 8 Sandler DA, Martin JF. Liquid crystal contact thermography as a screening test for deep-vein thrombosis. Lancet 1985; i: 665-668
- 9 Hoffmann R, Briitsch HP, Largiader F, Tittel R. Die “Liquid-Crystal-Contact Thermography” (LCCT) - Ein neues diagnostisches Ver-fahren zur Bestimmung der Hautdurchblutung. Erfahrungen nach 300 Untersuchungen. Helv Chir Acta 1989; 56: 263-266
- 10 Heaton DC, Billings JD, Hickton CM. Assessment of D dimer assays for the diagnosis of deep vein thrombosis. J Lab Clin Med 1987; 110: 588-591
- 11 Rowbotham BJ, Carroll P, Whitaker AN, Bunce IH, Cobcroft RG, Elms MJ, Masci PP, Bundesen PG, Rylatt DB, Webber AJ. Measurement of crosslinked fibrin derivatives - Use in the diagnosis of venous thrombosis. Thromb Haemostas 1987; 57: 59-61
- 12 Ott P, Astrup L, Hartving Jensen R, Nyeland B, Pedersen B. Assessment of D-dimer in plasma: diagnostic value in suspected deep venous thrombosis of the leg. Acta Med Scand 1988; 224: 263-267
- 13 Bounameaux H, Schneider PA, Reber G, de Moerloose P, Krahen-buhl B. Measurement of plasma D-dimer for diagnosis of deep venous thrombosis. Am J Clin Pathol 1989; 91: 82-85
- 14 Bounameaux H, Huber O, Khabiri E, Schneider PA, Didier D, Rohner A. Unexpectedly high rate of phlebographic deep venous thrombosis following elective general abdominal surgery among patients prophylaxed with low-molecular-weight heparin. Arch Surg. (in press)
- 15 Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed.. John Wiley & Sons Inc.; New York: 1981
- 16 Hanley JA, McNeil BJ. The meaning and use of the area under the receiving operator characteristic (ROC) curve. Radiology 1982; 143: 29-36
- 17 Cohen J. A coefficient of agreement for nominal scales. Educ Psych Means 1960; 20: 37-46
- 18 Bounameaux H, Cirafici P, de Moerloose P, Schneider PA, Slosman D, Reber G, Unger PF. Measurement of D-dimer in plasma as diagnostic aid in suspected pulmonary embolism. Lancet 1991; 337: 196-200
- 19 Goldhaber SZ, Vaughan DE, Tumeh SS, Loscalzo J. Utility of cross-linked fibrin degradation products in the diagnosis of pulmonary embolism. Am Heart J 1988; 116: 505-508
- 20 Boneu B, Bes G, Pelzer H, Sie P, Boccalon H. D-dimers, thrombin-antithrombin III complexes and prothrombin fragments 1 + 2: diagnostic value in clinically suspected deep vein thrombosis. Thromb Haemostas 1991; 65: 28-32
- 21 Elias A, Aillaud MF, Roul C, Villain Ph, Serradimigni A, Juhan-Vague I. Assessment of D-dimer measurement by ELISA or latex methods in deep vein thrombosis diagnosed by ultrasonic duplex scanning. Fibrinolysis 1990; 4: 237-240
- 22 Rowbotham BJ, Egerton-Vernon J, Whitaker AN, Elms MJ, Bunce IH. Plasma cross linked fibrin degradation products in pulmonary embolism. Thorax 1990; 45: 684-687
- 23 van Bergen PFMM, Knot EAR, Jonker JJC, de Boer AC, de Maat MPM. Is quantitative determination of fibrin(ogen) degradation products and thrombin-antithrombin III complexes useful to diagnose deep venous thrombosis in outpatients?. Thromb Haemostas 1989; 62: 1043-1045