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Aktuelle Kardiologie 2014; 3(1): 41-44
DOI: 10.1055/s-0033-1357895
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik der rezidivierenden Beinvenenthrombose und Lungenembolie

Diagnosis of Recurrent Deep Vein Thrombosis and Pulmonary Embolism
Sebastian M. Schellong
Krankenhaus Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der TU Dresden, Dresden
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. Februar 2014 (online)

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Zusammenfassung

Die venöse Thromboembolie ist eine chronische Erkrankung mit einem fortdauernden Risiko für ein Rezidiv. Tritt ein Rezidiv ein, sind Prognose und Behandlung des Patienten deutlich verändert, wobei beide ihre spezifischen Risiken nicht nur in der Akutphase, sondern besonders im Langzeitverlauf haben. Daher ist die korrekte Diagnose eines Rezidivs von größter Bedeutung. Die Diagnose einer ersten Episode folgt gut fundierten Algorithmen, deren Elemente die klinische Vortestwahrscheinlichkeit, der D-Dimer-Test und der Kompressionsultraschall der Beinvenen darstellen. Die Effizienz aller 3 Elemente ist bei einem Patienten mit Verdacht auf Rezidiv durch die vorhergehende Episode verschlechtert. Die vorliegende Übersicht fasst zusammen, was über die einzelnen diagnostischen Werkzeuge bekannt ist. Es stellt sich heraus, dass der für eine erste Episode gültige Algorithmus auch bei der Diagnose des Rezidivs verwendet werden kann, wenn man sich der schlechteren Effizienz bewusst ist.

Abstract

Venous thromboembolism is a chronic disease with a continuing risk of recurrence. In a patient with recurrence long-term prognosis and treatment are significantly altered both carrying their own risks not only in the acute phase but mainly in the long term perspective. Thus, accurate diagnosis of recurrence is of utmost importance for the fate of the patient. Diagnosis of a first VTE episode is well established and follows an algorithm including clinical prediction rules, D-Dimer testing and compression ultrasound. Due to the previous episode the efficiency of all three elements is impaired in a patient with suspected recurrence. The present review summarizes what is known about the performance of tools for VTE diagnosis, and gives personally weighed recommendations how to deal with this peculiar diagnostic situation. It turns out that the well accepted diagnostic algorithm for a first VTE may be applied as well if the lower efficiency is regarded.

Schlüsselwörter

Beinvenenthrombose - Lungenembolie - Rezidiv - klinische Vortestwahrscheinlichkeit - D-Dimer-Test - Kompressionssonografie - CT-Pulmonalisangiografie

Key words

deep vein thrombosis - pulmonary embolism - recurrence - clinical pretest probability - D-Dimer - venous ultrasound - CT angiography
 

  • Literatur

  • 1 Heit JA. Predicting the risk of venous thromboembolism recurrence. Am J Hematol 2012; 87 (Suppl. 01) S63-S67
    CrossrefPubMedGoogle Scholar
  • 2 Baglin T, Luddington R, Brown K et al. Incidence of recurrent venousthromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 2003; 362: 523-526
    CrossrefPubMedGoogle Scholar
  • 3 Boutitie F, Pinede L, Schulman S et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participantsʼ data from seven trials. BMJ 2011; 342: d3036
    CrossrefPubMedGoogle Scholar
  • 4 Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med 2005; 143: 129-139
    CrossrefPubMedGoogle Scholar
  • 5 Wells PS, Anderson DR, Bormanis J et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350: 1795-1798
    Google Scholar
  • 6 Wells PS, Anderson DR, Rodger M et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349: 1227-1235
    Google Scholar
  • 7 Wells PS, Anderson DR, Rodger M et al. Derivation of a simple clinical model to categorize patients with suspected pulmonary embolism. Ann Intern Med 1998; 129: 997-1005
    Google Scholar
  • 8 Wicki J, Perneger TV, Jnod AF et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001; 161: 92-97
    CrossrefPubMedGoogle Scholar
  • 9 Di Nisio M, Squizzato A, Rutjes AW et al. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost 2007; 5: 296-304
    CrossrefPubMedGoogle Scholar
  • 10 Elias A, Bonfils S, Daoud-Elias M et al. Influence of long term oral anticoagulants upon prothrombin fragment 1 + 2, thrombin-antithrombin III complex and D-Dimer levels in patients affected by proximal deep vein thrombosis. Thromb Haemost 1993; 69: 302-305
    PubMedGoogle Scholar
  • 11 Douketis J, Tosetto A, Marcucci MT et al. Patient-level meta-analysis: effect of measurement, timing, threshold, and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism. Ann Intern Med 2010; 153: 523-531
    CrossrefPubMedGoogle Scholar
  • 12 Rathbun SW, Whitsett TL, Raskob GE. Negative D-dimer result to exclude recurrent deep venous thrombosis: a management trial. Ann Intern Med 2004; 14: 839-845
    PubMedGoogle Scholar
  • 13 Bates SM, Kearon C, Kahn SR et al. A negative D-dimer excludes recurrent deep vein thrombosis: results of a multicentre management trial [abstract]. Blood 2007; 110: 214a
    PubMedGoogle Scholar
  • 14 Aguilar C, del Villar V. Combined D-dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis. Am J Hematol 2007; 82: 41-44
    CrossrefPubMedGoogle Scholar
  • 15 Prandoni P, Tormene D, Dalla Valle F et al. D-dimer as an adjunct to compression ultrasonography in patients with suspected recurrent deep vein thrombosis. J Thromb Haemost 2007; 5: 1076-1077
    CrossrefPubMedGoogle Scholar
  • 16 Le Gal G, Righini M, Roy PM et al. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med 2006; 166: 176-180
    CrossrefPubMedGoogle Scholar
  • 17 Prandoni P, Villalta S, Bagatella P et al. The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients. Haematologica 1997; 82: 423-428
    PubMedGoogle Scholar
  • 18 Piovella F, Crippa L, Barone M et al. Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica 2002; 87: 515-522
    PubMedGoogle Scholar
  • 19 Koopmann MM, Jongbloets L, Lensing AW et al. Clinical utility of a quantitative B-mode ultrasonography method in patients with suspected recurrent deep vein thrombosis (DVT). Thromb Haemost 1993; 69: 285a
    PubMedGoogle Scholar
  • 20 Prandoni P, Cogo A, Bernardi E et al. A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Circulation 1993; 88: 1730-1735
    CrossrefPubMedGoogle Scholar
  • 21 Prandoni P, Lensing AWA, Bernardi E et al. DERECUS Investigators Group. The diagnostic value of compression ultrasonography in patients with suspected recurrent deep vein thrombosis. Thromb Haemost 2002; 88: 402-406
    PubMedGoogle Scholar
  • 22 Le Gal G, Kovacs MJ, Carrier M et al. Validation of a diagnostic approach to exclude recurrent venous thromboembolism. J Thromb Haemost 2009; 7: 752-759
    CrossrefPubMedGoogle Scholar
  • 23 Hamadah A, Alwasaidi T, LE Gal G et al. Baseline imaging after therapy for unprovoked venous thromboembolism: a randomized controlled comparison of baseline imaging for diagnosis of suspected recurrence. J Thromb Haemost 2011; 9: 2406-2410
    CrossrefPubMedGoogle Scholar
  • 24 Heijboer H, Jongbloets LM, Büller HR et al. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis. Acta Radiol 1992; 33: 297-300
    CrossrefPubMedGoogle Scholar
  • 25 van Gogh Investigators. Buller HR, Cohen AT et al. Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med 2007; 357: 1094-1104
    CrossrefPubMedGoogle Scholar
  • 26 Nijkeuter M, Hovens MM, Davidson BL et al. Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review. Chest 2006; 129: 192-197
    CrossrefPubMedGoogle Scholar
  • 27 Donadini MP, Dentali F, Cosmi B et al. Presence of residual thromboemboli at least six months after a first episode of symptomatic pulmonary embolism: do perfusion scintigraphy and angio-computed tomography agree?. Thromb Haemost 2009; 102: 1287-1289
    PubMedGoogle Scholar
  • 28 Bates SM, Jaeschke R, Stevens SM et al. American College of Chest Physicians. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e351S-e418S
    CrossrefPubMedGoogle Scholar
  • 29 Ageno W, Squizzato A, Wells PS et al. The diagnosis of symptomatic recurrent pulmonary embolism and deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost 2013; 11: 597-602
    PubMedGoogle Scholar