Combined use of strain-gauge plethysmography and latex D-dimer test in clinically suspected deep venous thrombosis

Summary271 patients with acute symptomatic deep venous thrombosis of lower limbs, confirmed by strain-gauge plethysmography and/ or venography, were randomly assigned to receive intermittent subcutaneous heparin calcium or heparin sodium by continuous intravenous infusion for 6–10 days. Heparin dosage was adjusted to maintain activated partial thromboplastin time values (Throm-bofax reagent) at 1.3–1.9 times the basal ones. Strain-gauge plethysmography was repeated at the end of heparin treatment, and evaluation of therapy was performed by comparing the indexes of venous hemodynamics and by assessing the incidence of pulmonary embolism and of bleeding complications.In the intravenous group, Maximal Venous Outflow (MVO) increased from 20.8 ± 12.8 to 28.4 ± 17.5 ml/min per 100 ml of tissue and Venous Capacitance (VC) from 1.39 ± 0.92 to 1.94 ± 1.0 ml/100 ml of tissue (mean ± SD). In the subcutaneous group, MVO increased from 21.0 ± 12.7 to 27.5 ± 18.1 and VC from 1.60 ± 0.86 to 2.06 ± 1.0. The median improvement of MVO and VC were 22% and 36% respectively in the IV group and 20% and 24% in the SC group. Clinical pulmonary embolism occurred in 2 patients in the intravenous group (1 fatal) and in 4 in the subcutaneous group (1 fatal). 9 major bleeding complications occurred in the intravenous group (1 fatal) and 5 in the subcutaneous group (1 fatal). The differences were not significant at the statistical analysis.The results suggest that subcutaneous intermittent heparin has a comparable efficacy to continuous intravenous heparin in the treatment of deep venous thrombosis.To the same conclusion points an overview of the seven randomized trials which compared these treatment modalities.

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Venous Haemodynamics and Morphology in Relation to Recanalisation and Thrombus Resolution in Patients with Proximal Deep Venous Thrombosis

Phlebology The Journal of Venous Disease ◽

10.1177/026835559901400109 ◽

1999 ◽

Vol 14 (1) ◽

pp. 33-38 ◽

Cited By ~ 2

Author(s):

S. Rosfors ◽

A. Norén

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Strain Gauge ◽

Duplex Ultrasound ◽

Diagnostic Techniques ◽

Venous Outflow ◽

Diagnostic Laboratory ◽

Strain Gauge Plethysmography ◽

Venous Volume

Objective: Follow-up studies of deep venous thrombosis (DVT) are needed to gain increased knowledge of the process of recanalisation over time. In this study modern diagnostic techniques were used to analyse changes in venous circulation during the process of recanalisation and thrombus resolution. Design and setting: Prospective follow-up study of patients with symptomatic DVT referred to a vascular diagnostic laboratory. The patients were evaluated by repeated examinations with colour duplex ultrasound and computerised strain-gauge plethysmography. Patients: Eighteen consecutive patients with acute DVT occluding the calf veins and femoropopliteal vein segments. Main outcome measures: Ultrasonographic assessment of thrombus resolution and flow patterns in deep and superficial veins. Plethysmographic determination of venous volume and venous outflow capacity. Results: At 3 months' and 6 months' follow-up, 33% and 56%, respectively, were recanalised but almost all limbs still had some degree of functional outflow obstruction. Duplex evaluation further demonstrated a complex pattern of recanalisation with thrombus resolution from above, from below or both. Computerised strain-gauge plethysmography showed a progressive time-related increase in venous outflow capacity and venous volume over 6 months, but volumetric variables could not be used to distinguish between limbs with patent veins and those with still-occluded veins. None of the limbs had completely compressible femoropopliteal venous segments at the end of the follow-up. Conclusion: The combination of these two modern diagnostic techniques, suitable for repeated studies, can provide detailed information on morphological and haemodynamic changes occurring during the process of recanalisation and thrombus resolution.

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