DIAGNOSTIC WORK-UP AND DIAGNOSTIC SAFETY IN PATIENTS WITH SUSPECTED DEEP VEIN THROMBOSIS - DATA FROM THE GERMAN TULIPA REGISTRY

2007 ◽  
Vol 5 ◽  
pp. P-W-517-P-W-517
Author(s):  
S.M. Schellong ◽  
H. Gerlach ◽  
V. Hach-Wunderle ◽  
E. Rabe ◽  
H.B. Riess ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

A new rapid bedside assay for quantitative testing of D-Dimer (Cardiac D-Dimer) in the diagnostic work-up for deep vein thrombosis

2003 ◽  
Vol 111 (3) ◽  
pp. 149-153 ◽  
Author(s):  
Cristina Legnani ◽  
Simone Fariselli ◽  
Michela Cini ◽  
Gaetana Oca ◽  
Carmela Abate ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

Impact of gender on the clinical presentation and diagnosis of deep-vein thrombosis

2010 ◽  
Vol 103 (04) ◽  
pp. 710-717 ◽  
Author(s):  
Hanno Riess ◽  
Viola Hach-Wunderle ◽  
Horst Gerlach ◽  
Heike Carnarius ◽  
Sonja Eberle ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Presentation ◽  
Risk Groups ◽  
Pretest Probability ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

SummaryIt is uncertain whether gender influences the clinical presentation of deep-vein thrombosis (DVT) and the discriminative value of the Wells diagnostic pretest probability score. The aim of the study was to determine whether gender impacts the clinical presentation and diagnosis of DVT. The study analysed a cohort of 4,976 outpatients with clinically suspected DVT of the leg prospectively recruited by 326 vascular medicine physicians in the German ambulatory care sector between October and December 2005. The diagnosis of DVT was based on compression ultrasonography in 96% of patients. Among 4,777 patients who had a diagnostic work-up for DVT there were more women (n=2,998) than men (n=1,779). However, the prevalence of confirmed DVT was 37.0% (658/1779) in men vs. 24.3% (730/2,998) in women (p<0.001). Among patients with confirmed DVT, proximal DVT was more common in men (59.6% vs. 44.5% in women, p<0.001). Swelling of the leg, pitting oedema and dilated superficial veins were more frequently reported by men (p<0.001). The percentage of patients with a high probability Wells clinical pretest score was higher in men than in women (67.0% vs. 57.0%, p<0.001). However, overall, the score equally discriminated risk groups for DVT in both sexes. In conclusion, women were more frequently referred for a diagnostic work-up for DVT than men, but the prevalence of DVT was higher in men and their thrombotic events were more severe. Nevertheless, the Wells clinical pretest probability score correctly identified low- and high-risk groups in both genders.

Imaging for venous thrombosis

ESC CardioMed ◽  
2018 ◽  
pp. 2806-2810
Author(s):  
Frederikus A. Klok ◽  
Charlotte E. A. Dronkers ◽  
Menno V. Huisman
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Imaging Techniques ◽  
Clinical Decision ◽  
Cerebral Vein ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Test Probability

The diagnostic work-up of upper and of lower extremity deep vein thrombosis starts with the assessment of the pre-test probability by using a validated clinical decision rule, followed by imaging if deep vein thrombosis cannot reliably be rule out. For splanchnic vein thrombosis and cerebral vein thrombosis, the diagnostic assessment starts with imaging. Currently, the imaging techniques most widely used in clinical practice are compression ultrasonography, computed tomography, and magnetic resonance imaging, with a diagnostic standard dependent on the specific site of the venous thrombosis. This chapter provides an overview of the diagnostic accuracy and potential pitfalls of imaging techniques for the different sites of venous thrombosis.

The role of fibrin monomers in optimizing the diagnostic work-up of deep vein thrombosis

2007 ◽  
Vol 97 (05) ◽  
pp. 807-813 ◽  
Author(s):  
Fred Haas ◽  
Mariette Agterof ◽  
Marike Vos ◽  
Douwe Biesma ◽  
Roger Schutgens
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Score ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Diagnostic Work ◽  
Additional Value ◽  
Deep Vein ◽  
Work Up ◽  
Fibrin Monomers ◽  
D Dimer

SummaryDespite the use of a clinical score and D-dimers to exclude deep vein thrombosis (DVT), the majority of patients still need repeated ultrasound (US).The aim of the study was to investigate whether fibrin monomers (FMs), as markers of thrombin generation, have additional value in the diagnosis of DVT. This is a posthoc analysis of 464 outpatients, participants in a management study using D-dimers (Tina-Quant® ) and a clinical score in the exclusion of DVT. Two new FM assays (Auto LIA-FM® and IATRO SF®, Japan) were performed. Overall sensitivity, negative predictive value (NPV) and specificity of the D-dimer test were 98%, 98% and 42%.The optimal cut-off point for the Auto LIAFM test was ≤ 3 µ g/ml with values of 88%, 88% and 59%, respectively. The IATRO SF test had an optimal cut-off point of ≤ 2 µ g/ ml with values of 92%, 81 and 22%, respectively.The NPV of a non-high clinical score and a normal D-dimer (n=97) was 100%. In patients with a high clinical score (n=160), the NPV of the D-dimer was 88%. In these patients, a single US combined with a normal D-dimer or FM test had an equal NPV as serial US (100 versus 98%, respectively) and lead to a reduction in the need for US by 36–53%, respectively. In patients with abnormal D-dimer concentrations (n=343), a normal US combined with a normal Auto LIA-FM test had a NPV of 97%,which was also true for serial US.This could lead to a reduction in the need for US by 45%. The present studied FMs are inferior to theTina-Quant D-dimer test when used as primary screening tool to exclude DVT.Adding these FMs to patients with a normal Tina-Quant D-dimer has no benefit. In patients with a high pretest clinical probability score, a single US in combination with a normal D-dimer or FM test might be as safe as serial US. In patients with abnormal D-dimer concentrations and a normal US, a normal FM test might be able to replace the second US.

scholarly journals The Diagnostic Performance of a Non-Emergency Department-Based Deep Vein Thrombosis Ambulatory Care Pathway

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3405-3405
Author(s):  
Pape-Mamadou Sene ◽  
Denis Yahiaoui ◽  
Maral Koolian ◽  
Vicky Tagalakis
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Diagnostic Performance ◽  
Care Pathway ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

Background Ambulatory management of isolated acute deep vein thrombosis (DVT) is the standard of care in most patient populations, and in clinical practice is mostly initiated in the emergency department (ED). However, patients referred to the ED with suspected DVT often experience unnecessary delays to diagnosis and subsequent long stays to determine appropriate treatment and follow up care. We implemented a DVT ambulatory care pathway that does not include the ED for referred patients with suspected isolated DVT that begins with pre-test risk stratification in the community and subsequent algorithm-based diagnostic work-up, treatment, and follow-up at a tertiary care centre in Montreal Canada. Objective To determine the diagnostic performance of a non-ED based DVT ambulatory care pathway. Methods We determined the prevalence of DVT over a 46 week period between August 2018 and June 2019 among ambulatory patients with suspected isolated DVT who following community-based risk stratification using the modified Well's clinical prediction score were referred for diagnostic work up and treatment using a newly implemented non-ED based DVT ambulatory care pathway. Results Among 122 patients referred by community physicians, 86 (70%) met pre-defined pathway criteria for assessment of suspected DVT. In all, 42 (49%) were referred with an unlikely/low modified Well's score and 44 (51%) with a likely/high score. Overall, the prevalence of DVT was 19.8%, specifically 9.5% in the unlikely/low and 30.2% in the likely/high pretest probability groups, respectively. Conclusion Our results show that the diagnostic performance of a non-ED based acute DVT ambulatory care pathway is in line with literature estimates. The advantage of this pathway is that it offers clear, evidence-based guidance for community physicians to diagnosis and treat patients in an ambulatory setting without using the ED. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter ED stays. Disclosures Tagalakis: Sanofi Aventis: Other: investigator initiated grant;participated on ad boards; Pfizer: Other: participated on ad boards; BMS-Pfizer: Other: participated on ad boards; Servier: Other: participated on ad boards; Bayer: Other: participated on ad boards.

scholarly journals Vaccine-Induced Thrombotic Thrombocytopenia: Novelty Testing in the Diagnostic Work-up?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1061-1061
Author(s):  
Rossella Rosari Cacciola ◽  
Veronica Vecchio ◽  
Elio Gentilini Cacciola ◽  
Emma Cacciola
Keyword(s):  
Conflicts Of Interest ◽  
Clot Lysis ◽  
Clotting Time ◽  
Vein Thrombosis ◽  
History Of ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Maximum Clot Firmness

Abstract COVID-19 vaccination campagnies with several vaccines types are currently undeway. Recently, the ASTRA ZENECA vaccine has raised public alarm with concerns regarding the development of thrombotic events known as vaccine-induced thrombotic thrombocytopenia (VITT). Early and limited studies have implicated an antibody-mediated platelet activation as the mechanism of the clotting events. Aim of this study was to investigate the platelet and coagulation activation using specialized tests. In this study we enrolled 60 patients (40 men, 20 women; mean age 55±10 years) without cardiovascular risk factors or a history of thrombosis who reported having poplitea deep vein thrombosis (35/60) and pulmonary embolism (25/60) revealed with lower-limb ultrasonography and computed tomography (CT) angiography, respectively, 7 days after vaccination with ASTRA ZENECA. All patients were evaluated for initial testing such as platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer (DD). Platelets were measured by automated analyzer, PT and APTT by coagulometric test, Fib using Clauss method, and DD using ELISA. Complete blood hemostasis was studied by platelet function assay (PFA-100) on Collagen/ADP (CT-ADP) and Collagen/Epinephrine (CT-EPI) cartridges and Thromboelastometry method on Clotting Time (CT), Clotting Formation Time (CFT), Maximum Clot Firmness (MCF), and clot lysis at 30 minutes (LY-30). All patients had thrombocytopenia (60±5x109/L), longer PT (28±10 s) and PTT (50±10 s), lower Fib (80±20 mg/dl), higher DD ((550±100 mg/l). All patients had shorter C/ADP and C/EPI (C/ADP, n.v. 68-121 s (42±10 s) and C/EPI n.v. 84-160 s (38±5 s) and shorter CT (CT, unit: s. n.v. 100-240 s) (INTEM 30±20 s, EXTEM 18±10 s), shorter CFT (CFT, unit: s, n.v. 30-160 s (INTEM 11±10 s, EXTEM 19±10 s), longer MCF (MCF, unit: mm, n.v. 50-72 mm (INTEM 128±10 mm, EXTEM 110±10 mm), and lower LY-30 (LY-30, %: v.n. 15% (INTEM 0.8%, EXTEM 0.7%). These interesting findings may be the novelty in the diagnostic work-up of the VITT. If these tests may aid in the diagnosis of VITT deserve to be confirmed and need reproducing in other studies. Disclosures No relevant conflicts of interest to declare.

Diagnosis of deep-vein thrombosis: Adherence to guidelines and outcomes in real-world health care

2009 ◽  
Vol 102 (12) ◽  
pp. 1234-1240 ◽  
Author(s):  
Horst Gerlach ◽  
Viola Hach-Wunderle ◽  
Eberhard Rabe ◽  
Hanno Riess ◽  
Heike Carnarius ◽  
...  
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Ambulatory Care ◽  
Real World ◽  
Diagnostic Methods ◽  
World Health ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Work Up ◽  
Current Guidelines

SummaryCurrent guidelines recommend optimised algorithms for diagnosis of suspected deep-vein thrombosis (DVT). There is little data to determine to what extent real-world health care adheres to guidelines, and which outcome in terms of diagnostic efficiency and safety is achieved. This registry involved patients with clinically suspected DVT of the leg recruited in German ambulatory care between October and December 2005. Registry items were: diagnostic methods applied; diagnostic categories at day 1; and venous thromboembolic events up to 90 days in patients without firmly established DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%).The rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]: 0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50% (95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.The TULIPA registry was funded by GlaxoSmithKline GmbH und Co KG, Munich.

scholarly journals A Case Study of Deep Vein Thrombosis of the Right Internal Jugular Vein in a Healthy 21-Year-Old Male

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Javier Corral ◽  
Geri Villanueva
Keyword(s):  
Deep Vein Thrombosis ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Significant Past Medical History ◽  
Vein Thrombosis ◽  
The Right ◽  
Deep Vein ◽  
Work Up

We are reporting a case of a healthy 21-year-old male, with no significant past medical history, who was found to have an incidental nonocclusive deep vein thrombosis in the right internal jugular vein detected on a head MRI previously ordered for work-up of headaches. A follow-up upper extremity venous Doppler ultrasound confirmed the presence of a partially occlusive deep vein thrombosis in the right jugular vein. The case presented is unique for the reason that the patient is young and has no prior risk factor, personal or familial, for venous thrombosis except for associated polycythemia on clinical presentation.

Diagnostic and Technical Challenges in the Care of a Complex Patient With Post-Thrombotic Syndrome

2021 ◽  
pp. 153857442199502
Author(s):  
Shin Mei Chan ◽  
Alfred Lee ◽  
Bhaskar Roy ◽  
Cassius Iyad Ochoa Chaar
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Success ◽  
Symptomatic Relief ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Complex Patient ◽  
Venous Recanalization ◽  
Technical Challenges ◽  
Deep Vein ◽  
Work Up

Iliofemoral deep vein thrombosis can lead to post-thrombotic syndrome, a costly and morbid condition. Endovascular treatment is increasingly used for symptomatic relief, but clinical success depends on accurate patient evaluation and selection. This case describes the diagnostic and technical challenges in the care of a complex patient with post-thrombotic syndrome following stroke and extensive deep vein thrombosis. It highlights the multi-disciplinary work-up for a patient with post-thrombotic syndrome presenting with confounding symptoms, as well as the importance of considering alternative access for successful lower extremity venous recanalization.

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