Tiefe Venenthrombose – Diagnostik und Abklärung Schritt für Schritt

Zusammenfassung

Die frühzeitige Diagnose und Therapie von tiefen Venenthrombosen vermindern das Risiko für eine Lungenembolie und ein postthrombotisches Syndrom. In diesem Beitrag wird erklärt, welche Schritte für die Diagnosestellung von Bedeutung sind und welche Ursachen der tiefen Venenthrombose zugrunde liegen können.

Abstract

Deep vein thrombosis usually manifests as leg or pelvic vein thrombosis (DVT). The causes are either acquired or inherited and can also occur in combination. Early diagnosis and treatment of DVT can reduce the risk of pulmonary embolism and postthrombotic syndrome. The estimation of the clinical probability, if necessary in combination with the D-dimer test, points the way to further imaging diagnostics. After diagnosis, risk factors that led to the occurrence of thrombosis can be identified in many cases. In more than half of the cases, genetic causes play a role. If the cause is not clear, tumor screening should be performed, since up to 20 % of thromboses are due to tumor disease.

Schlüsselwörter

tiefe Venenthrombose - Diagnostik - Abklärung

Key words

deep vein thrombosis - diagnostics - clarification

• Literatur

• 1 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
• 2 Wells PS, Owen C, Doucette S. et al. Does this patient have deep vein thrombosis?. JAMA 2006; 295: 199-207
• 3 Wells PS, Anderson DR, Rodger M. et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. The New England journal of medicine 2003; 349: 1227-1235
• 4 Aguilar C, del Villar V. Diagnostic performance of D-dimer is lower in elderly outpatients with suspected deep venous thrombosis. Br J Haematol 2005; 130: 803-804 ; author reply 805
• 5 Schouten HJ, Geersing GJ, Koek HL. et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ 2013; 346: f2492
• 6 Righini M, Van Es J, Den Exter PL. et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014; 311: 1117-1124
• 7 Farm M, Siddiqui AJ, Onelov L. et al. Age-adjusted D-dimer cut-off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays. J Thromb Haemost 2018; 16: 866-875
• 8 Bagot CN, Arya R. Virchow and his triad: a question of attribution. Br J Haematol 2008; 143: 180-190
• 9 Mateo J, Oliver A, Borrell M. et al. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism--results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost 1997; 77: 444-451
• 10 Margaglione M, Brancaccio V, Giuliani N. et al. Increased risk for venous thrombosis in carriers of the prothrombin G-->A20210 gene variant. Ann Intern Med 1998; 129: 89-93
• 11 Crowther MA, Kelton JG. Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system. Ann Intern Med 2003; 138: 128-134
• 12 Dahlback B. Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 2008; 112: 19-27
• 13 Lindhoff-Last E, Luxembourg B. Evidence-based indications for thrombophilia screening. Vasa 2008; 37: 19-30
• 14 McColl MD, Ramsay JE, Tait RC. et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78: 1183-1188
• 15 Bertina RM. Genetic approach to thrombophilia. Thromb Haemost 2001; 86: 92-103
• 16 Heit JA, O'Fallon WM, Petterson TM. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248
• 17 Bauer KA. Venous thromboembolism in malignancy. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2000; 18: 3065-3067
• 18 Elting LS, Escalante CP, Cooksley C. et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med 2004; 164: 1653-1661
• 19 Prandoni P, Lensing AW, Buller HR. et al. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. The New England journal of medicine 1992; 327: 1128-1133
• 20 Douketis JD, Gu C, Piccioli A. et al. The long-term risk of cancer in patients with a first episode of venous thromboembolism. J Thromb Haemost 2009; 7: 546-551
• 21 Martinelli I. Risk factors in venous thromboembolism. Thromb Haemost 2001; 86: 395-403
• 22 Ocak G, Vossen CY, Verduijn M. et al. Risk of venous thrombosis in patients with major illnesses: results from the MEGA study. J Thromb Haemost 2013; 11: 116-123
• 23 Peragallo Urrutia R, Coeytaux RR, McBroom AJ. et al. Risk of acute thromboembolic events with oral contraceptive use: a systematic review and meta-analysis. Obstet Gynecol 2013; 122: 380-389
• 24 Stegeman BH, de Bastos M, Rosendaal FR. et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ 2013; 347: f5298
• 25 Bloemenkamp KW, Rosendaal FR, Helmerhorst FM. et al. Higher risk of venous thrombosis during early use of oral contraceptives in women with inherited clotting defects. Arch Intern Med 2000; 160: 49-52
• 26 Roach RE, Lijfering WM, Helmerhorst FM. et al. The risk of venous thrombosis in women over 50 years old using oral contraception or postmenopausal hormone therapy. J Thromb Haemost 2013; 11: 124-131