Wells Clinical Probability and D-dimer Testing: Risk Stratification for Acute Lower Extremity Deep Vein Thrombosis

Objective: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). Methods: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. Results: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level ( P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. Conclusion: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.

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Clinical Probability Assessment and D-Dimer Determination in Patients with Suspected Deep Vein Thrombosis, a Prospective Multi-Center Management Study

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.06.025 ◽

2009 ◽

Vol 50 (2) ◽

pp. 467 ◽

Cited By ~ 1

Author(s):

J.L. Elf ◽

K. Strandberg ◽

C. Nilsson

Keyword(s):

Deep Vein Thrombosis ◽

Probability Assessment ◽

Management Study ◽

Vein Thrombosis ◽

Clinical Probability ◽

Deep Vein ◽

D Dimer

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Deep Vein Thrombosis in the Uninjured Limb in Patients with Lower Extremity Fractures: A Retrospective Study

BioMed Research International ◽

10.1155/2020/1647617 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Peng-Fei Wang ◽

Jia-Hao Li ◽

Chen Fei ◽

Zhi Li ◽

Chao Ke ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Lower Extremity ◽

Doppler Ultrasonography ◽

Vein Thrombosis ◽

Independent Risk Factors ◽

Level 1 ◽

Deep Vein ◽

Actual Incidence ◽

D Dimer

Objective. This study is aimed at investigating the incidence of deep vein thrombosis (DVT) in the uninjured limb during hospitalization and 1 month after surgery in patients with lower extremity fractures. Methods. We collected the clinical data of patients with lower extremity fractures in Xi’an Honghui Hospital. Doppler ultrasonography was used to diagnose DVT. According to the results of ultrasonography, the patients were divided into two groups: uninjured limb with DVT group and uninjured limb without DVT group. Results. A total of 494 patients who met all inclusion criteria were included in this study. The incidence rate of DVT in the uninjured limb was 19.84% and 18.83% during hospitalization and 1 month after surgery, respectively. Age (OR=1.035, 95% CI: 1.013–1.059; P=0.002) and D-dimer level 1 day after surgery (OR=1.065, 95% CI: 1.030–1.102; P<0.001) were independent risk factors for DVT during hospitalization. Similarly, age (OR=1.045, 95% CI: 1.021–1.070; P<0.001) and D-dimer level 1 day after surgery (OR=1.048, 95% CI: 1.014–1.083; P=0.006) were independent risk factors for DVT 1 month after surgery. During hospitalization and 1 month after surgery, 15.79% and 12.35% of patients had double lower limb thrombosis and 4.04% and 6.48% of patients had DVT in the uninjured limb only, respectively. Conclusion. The actual incidence of DVT in the uninjured limb in patients with lower extremity fractures cannot be ignored despite the use of anticoagulants for prevention or treatment during hospitalization. We should also be aware of DVT in the uninjured limb while focusing on DVT in the injured limb.

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Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th17-03-0182 ◽

2017 ◽

Vol 117 (10) ◽

pp. 1937-1943 ◽

Cited By ~ 9

Author(s):

Jim Julian ◽

Lori-Ann Linkins ◽

Shannon Bates ◽

Clive Kearon ◽

Sarah Takach Lapner

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Diagnostic Accuracy ◽

Blood Samples ◽

Vein Thrombosis ◽

Clinical Probability ◽

Deep Vein ◽

New Strategies ◽

D Dimer

SummaryTwo new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7%) and the age-adjusted strategy (99.6%) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1% vs, 50.9%; difference 5.2%; 95% CI 3.5% to 6.8%). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

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Combined use of pretest clinical probability score and latex agglutination D-dimer testing for excluding acute deep vein thrombosis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.06.059 ◽

2009 ◽

Vol 50 (5) ◽

pp. 1099-1105 ◽

Cited By ~ 19

Author(s):

Takashi Yamaki ◽

Motohiro Nozaki ◽

Hiroyuki Sakurai ◽

Yuji Kikuchi ◽

Kazutaka Soejima ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Latex Agglutination ◽

Probability Score ◽

Vein Thrombosis ◽

Clinical Probability ◽

Combined Use ◽

Acute Deep Vein Thrombosis ◽

Deep Vein ◽

D Dimer

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Age-adjusted D-dimer for the diagnosis of deep vein thrombosis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517718762 ◽

2017 ◽

Vol 33 (7) ◽

pp. 458-463 ◽

Cited By ~ 5

Author(s):

Efrem Gómez-Jabalera ◽

Sergio Bellmunt Montoya ◽

Eva Fuentes-Camps ◽

José Román Escudero Rodríguez

Keyword(s):

Deep Vein Thrombosis ◽

False Negative ◽

Intermediate Risk ◽

Vein Thrombosis ◽

Clinical Probability ◽

Specificity And Sensitivity ◽

Wells Score ◽

Risk Patients ◽

Deep Vein ◽

D Dimer

Objective In the diagnosis of deep vein thrombosis, new D-dimer cut-off values were defined by multiplying 10 µg/L × age. The objective of the present study is to define a more specific age-adjusted value, including the pre-test Wells score, without worsening sensitivity. Methods We designed a case–control study in patients attended in the emergency department with clinically suspected deep vein thrombosis. Demographics, Wells score, D-dimer and ultrasound data were collected. In low and intermediate clinical probability cases for deep vein thrombosis, we determined the specificity and sensitivity (false-negative rates) for the following cut-off values of D-dimer: age × 10 µg/L, age × 15 µg/L, age × 20 µg/L, age × 25 µg/L and age × 30 µg/L. The cut-off value with maximum specificity without any false-negative result (sensitivity 100%) was identified. Results We included 138 consecutive patients, 39.9% were men and the mean age was 71.6 years. Deep vein thrombosis was diagnosed in 16.7% of patients and the Wells score was low in 69.6%, intermediate in 21% and high in 9.4% of patients. Applying the conventional cut-off value of 500 µg/L, the specificity was 21.1% with a sensitivity of 100%. Maintaining 100% sensitivity, the highest specificity was reached with a cut-off value for D-dimer equivalent to the age × 25 µg/L in low-risk patients (67.1% specificity) and the age × 10 µg/L (50% specificity) in intermediate-risk patients. Conclusions In patients with low Wells score, the cut-off value can be raised to age × 25 µg/L in order to rule out deep vein thrombosis without jeopardizing safety. In intermediate-risk patients, the D-dimer cut-off value could be raised to age × 10 µg/L as previously suggested.

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Risk Stratification Model: Lower-Extremity Ultrasonography for Hospitalized Patients with Suspected Deep Vein Thrombosis

Journal of General Internal Medicine ◽

10.1007/s11606-017-4170-3 ◽

2017 ◽

Vol 33 (1) ◽

pp. 21-25 ◽

Cited By ~ 4

Author(s):

Emily C. Alper ◽

Ivan K. Ip ◽

Patricia Balthazar ◽

Gregory Piazza ◽

Samuel Z. Goldhaber ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Risk Stratification ◽

Lower Extremity ◽

Hospitalized Patients ◽

Vein Thrombosis ◽

Risk Stratification Model ◽

Deep Vein

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Incidence and predictors of occult preoperative deep vein thrombosis at radical cystectomy for urothelial carcinoma

Canadian Urological Association Journal ◽

10.5489/cuaj.6852 ◽

2021 ◽

Vol 15 (9) ◽

Author(s):

Tanner S. Miest ◽

Vidit Sharma ◽

R. Jeffrey Karnes ◽

Stephen A. Boorjian ◽

R. Houston Thompson ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Neoadjuvant Chemotherapy ◽

Positive Predictive Value ◽

Lower Extremity ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Predictive Value ◽

Vein Thrombosis ◽

Deep Vein ◽

D Dimer

Introduction: Patients undergoing radical cystectomy are at high perioperative risk for deep vein thrombosis due to age, malignancy, recent transurethral resection, and neoadjuvant chemotherapy. We, therefore, evaluated the incidence and predictors of occult preoperative deep vein thrombosis prior to radical cystectomy for urothelial carcinoma. Methods: We prospectively screened 52 asymptomatic patients with urothelial carcinoma undergoing radical cystectomy at our institution with lower extremity ultrasound and D-dimer assay within two weeks prior to surgery. Patients with a prior history of deep vein thrombosis and those on systemic anticoagulation were excluded. Results: We identified 4/52 patients (7.7%) with preoperative asymptomatic deep vein thrombosis prior to radical cystectomy. Median D-dimer for patients with and without preoperative deep vein thrombosis was 787 ng/ml(interquartile range [IQR] 365–1257) and 260 ng/ml(IQR 158–498), respectively. A D-dimer threshold of >250 ng/ml had a sensitivity of 100% and specificity of 50%, resulting in a negative predictive value of 100% and positive predictive value of 14.8% for preoperative deep vein thrombosis. Increasing the D-dimer threshold to >1000 ng/ml created a sensitivity of 50% and specificity of 85%, resulting in a negative predictive value of 92% and positive predictive value of 33%. D-dimer values did not significantly vary with neoadjuvant chemotherapy or days since transurethral resection. Conclusions: Approximately 8% of patients had an occult deep vein thrombosis prior to radical cystectomy. D-dimer can provide sensitive diagnostic utility for deep vein thrombosis in the pre-radical cystectomy setting and could help guide use of preoperative lower extremity ultrasound in this high-risk patient population.

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Clinical Predictive Factors of Lower Extremity Deep Vein Thrombosis in Relative High-Risk Patients after Neurosurgery: A Retrospective Study

Disease Markers ◽

10.1155/2020/5820749 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Juhua Li ◽

XinZhen Ren ◽

Xiaole Zhu ◽

Huayu Chen ◽

Zhen Lin ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Lower Extremity ◽

Predictive Factors ◽

High Risk Patients ◽

Vein Thrombosis ◽

Risk Patients ◽

Gcs Score ◽

Deep Vein ◽

D Dimer

Introduction. It is acknowledged that patients undergoing neurosurgery with neurological illness are at higher risk of lower extremity deep vein thrombosis (DVT). As an underlying life-threatening complication, the incidence and risk factors for high-risk patients with lower extremity deep vein thrombosis are still controversial in relative high-risk patients after neurosurgery. Materials and Methods. A total of 204 patients who underwent neurosurgery and were considered as a high-risk group of DVT according to times of stay in bed more than 3 days were enrolled in this study. We evaluated the lower extremity DVT by using Color Doppler Ultrasound System (CDUS). Clinical parameters of patients at the time of admission and postoperation were recorded and prepared for further analysis. Early predictive factors for postoperative lower extremity DVT were established. Diagnostic performance of predictive factors was evaluated by using receiver operating characteristic (ROC) curve analysis. Results. The overall incidence rate of DVT in 204 enrolled patients was 30.9%. Multivariate logistic regression indicated that hypertension (OR 3.159, 95% CI 1.465-6.816; P=0.003), higher postoperative D-dimer (OR 1.225, 95% CI 1.016-1.477; P=0.034), female (OR 0.174, 95% CI 0.054-0.568; P=0.004), and lower GCS score (OR 0.809, 95% CI 0.679-0.965; P=0.013) were independently associated with incidence of DVT in patients after neurosurgery. The logistic regression function (LR model) of these four independent risk factors had a better performance on diagnostic value of DVT in patients after neurosurgery. Conclusion. The combined factor was constructed by hypertension, postoperative D-dimer, gender, and GCS score, and it might be a more handy and reliable marker to stratify patients at risk of DVT after neurosurgery.

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