Mandatory contrast-enhanced venography to detect deep-vein thrombosis (DVT) in studies of DVT prophylaxis: upsides and downsides

Jack Hirsh; Jeffrey S. Ginsberg; Noel Chan; Gordon Guyatt; John W. Eikelboom

doi:10.1160/TH13-07-0562

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 111(01): 10-13
DOI: 10.1160/TH13-07-0562

Clinical Focus

Schattauer GmbH

Mandatory contrast-enhanced venography to detect deep-vein thrombosis (DVT) in studies of DVT prophylaxis: upsides and downsides

Authors

Jack Hirsh

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Jeffrey S. Ginsberg

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Noel Chan

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Gordon Guyatt

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada
John W. Eikelboom

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Abstract

Summary

The introduction of venography into patient care was a major advance because it was the first accurate method for the diagnosis of DVT. Compression ultrasound has since become the preferred test for patients with suspected DVT because, unlike venography, it is simple, non-invasive and widely available. Venography has facilitated the development and approval of new anticoagulants and remains widely used as an efficacy outcome in trials of venous thromboembolism prevention. Most thrombi detected by screening venography are, however, small and unimportant for patients. In order to calculate the trade-off between an asymptomatic thrombus and a bleed we require an estimate of the number of asymptomatic thrombi that must be prevented to avoid a patient-important thrombus. A credible estimate of this ratio is not available. Therefore when used as a measure of efficacy in trials of thromboprophylaxis, venography has limitations for comparing the relative effects of alternative antithrombotic agents on outcomes important to patients.

Keywords

Deep-vein thrombosis - venous thrombosis - prophylaxis

Full Text

References

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