Download PDF
Semin Vasc Med 2001; 01(1): 039-042
DOI: 10.1055/s-2001-14540
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Clinical and Laboratory Diagnosis of Deep Vein Thrombosis: New Cost-Effective Strategies

Henri Bounameaux1 , Arnaud Perrier2 , Philip S. Wells3
  • 1Division of Angiology and Hemostasis, Medical Clinic, University Hospital of Geneva, Geneva, Switzerland
  • 2Department of Internal Medicine, Medical Clinic, University Hospital of Geneva, Geneva, Switzerland
  • 3Division of Hematology, Ottawa Civic Hospital, Ottawa, Canada
Further Information

Publication History

Publication Date:
31 December 2001 (online)

    Permissions and Reprints

ABSTRACT

Diagnosis of deep vein thrombosis (DVT) has been made easier, less invasive, and somewhat safer over the past 2 decades. This has been due mainly to the development of venous compression ultrasonography (US). The prevalence of the disease in patients clinically suspected of DVT has steadily decreased during the past 10 years, likely as a consequence of the accurate noninvasive test, ultrasound imaging. This has led to the development of diagnostic tools that aim at reducing the number of unnecessary US exams. These include clinical probability assessment and fibrin D-dimer. Several strategies combining these tools have been validated in large-outcome studies and compared in a formal cost-effectiveness analysis. The results indicate that they should now be implemented in daily practice, taking into account local facilities and expertise.

KEYWORD

Deep vein thrombosis - venous compression ultrasonography - D-dimer

REFERENCES

  • 1 Lensing A W, Prandoni P, Prins M H, Büller H R. Deep-vein thrombosis.  Lancet . 1999;  353 479-485
    CrossrefPubMedGoogle Scholar
  • 2 Sandler D A, Duncan J S, Ward P. Diagnosis of deep-vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmography, and venoscan with X-ray venogram.  Lancet . 1984;  1 716-719
    PubMedGoogle Scholar
  • 3 Wells P S, Anderson D R, Bormani J. Value of assessment of pretest probability of deep-vein thrombosis in clinical management.  Lancet . 1997;  350 1795-1798
    Google Scholar
  • 4 Cogo A, Lensing A WA, Koopman M MW. Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study.  BMJ . 1998;  316 17-20
    Google Scholar
  • 5 Bernardi E, Prandoni P, Lensing A W. 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 1037-1040
    CrossrefPubMedGoogle Scholar
  • 6 Perrier A, Desmarais S, Miron M J. Non-invasive diagnosis of venous thromboembolism in outpatients.  Lancet . 1999;  353 190-195
    Google Scholar
  • 7 Miron M J, Perrier A, Bounameaux H. Clinical probability of deep vein thrombosis: comparison between a score and an empirical assessment.  J Intern Med . 2000;  247 249-254
    CrossrefPubMedGoogle Scholar
  • 8 Bigaroni A, Perrier A, Bounameaux H. Is clinical probability assessment of deep vein thrombosis by a score really standardized?.  Thromb Haemost . 2000;  83 788-789
    PubMedGoogle Scholar
  • 9 Bounameaux H, de Moerloose P, Perrier A, Miron M J. D-dimer testing in suspected venous thromboembolism: an update.  QJM . 1997;  90 437-442
    CrossrefPubMedGoogle Scholar
  • 10 Ginsberg J S, Kearon C, Douketis J. The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis.  Arch Intern Med . 1997;  157 1077-1081
    CrossrefPubMedGoogle Scholar
  • 11 Wells P S, Anderson D R, Bormanis J, Guy F, Mitchell M, Lewandowski B. SimpliRED D-dimer can reduce the diagnostic tests in suspected deep vein thrombosis.  Lancet . 1998;  351 1405-1406
    CrossrefPubMedGoogle Scholar
  • 12 Kearon C, Ginsberg J S, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism.  Ann Intern Med . 1998;  129 1044-1049
    Google Scholar
  • 13 Kakkar V V, Flanc C, Howe C T, Clarke M B. Natural history of postoperative deep-vein thrombosis.  Lancet . 1969;  2 230-232
    Google Scholar
  • 14 Bounameaux H, Perrier A. Rapid diagnosis of deep vein thrombosis in symptomatic patients: a comparison between four different diagnostic strategies.  Thromb Haemost . 1999;  82 1360-1361
    PubMedGoogle Scholar
  • 15 Bounameaux H, Perrier A. Compression ultrasonography for diagnosing deep vein thrombosis. Repeat testing is unjustified.  BMJ . 1998;  316 1534-1535
    PubMedGoogle Scholar
  • 16 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg.  Arch Surg . 1972;  104 134-144
    PubMedGoogle Scholar
  • 17 Bounameaux H, Perrier A. Rapid diagnosis of deep vein thrombosis: a comparison between four strategies.  Thromb Haemost . 1999;  82 1360-1361
    PubMedGoogle Scholar
  • 18 Hull R, Hirsh J, Sackett D L. Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis.  Circulation . 1981;  64 622-625
    CrossrefPubMedGoogle Scholar
  • 19 Perone N, Bounameaux H, Perrier A. Comparison of four strategies for diagnosing deep vein thrombosis: a cost-effectiveness analysis.  Am J Med . 2001;  110 33-40
    Google Scholar
      >