Can the Combination of Clinical Risk Assessment and ELISA D-dimer Testing Reduce the Need for Duplex Ultrasound in the ED Diagnosis of Acute Lower-extremity Deep Vein Thrombosis?

2002 ◽  
Vol 9 (5) ◽  
pp. 361-b-362
Author(s):  
K. Ilkhanipour
Keyword(s):  
Risk Assessment ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Duplex Ultrasound ◽  
Vein Thrombosis ◽  
Clinical Risk ◽  
Clinical Risk Assessment ◽  
Deep Vein ◽  
D Dimer

scholarly journals Combination of a clinical risk assessment score and rapid whole blood D-dimer testing in the diagnosis of deep vein thrombosis in symptomatic patients

1999 ◽  
Vol 30 (5) ◽  
pp. 794-804 ◽  
Author(s):  
Andrew F. Lennox ◽  
Konstantinos T. Delis ◽  
Samuel Serunkuma ◽  
Zak A. Zarka ◽  
Styliani E. Daskalopoulou ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Deep Vein Thrombosis ◽  
Whole Blood ◽  
Assessment Score ◽  
Vein Thrombosis ◽  
Clinical Risk ◽  
Clinical Risk Assessment ◽  
Deep Vein ◽  
D Dimer

scholarly journals Study on the Risk Factors of Preoperative Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

2021 ◽  
Vol 27 ◽  
pp. 107602962110029
Author(s):  
Wenjie Chang ◽  
Bin Wang ◽  
Qiwei Li ◽  
Yongkui Zhang ◽  
Wenpeng Xie
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Color Doppler ◽  
Fracture Site ◽  
Vein Thrombosis ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Deep Vein ◽  
D Dimer

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.

scholarly journals Acute Deep Vein Thrombosis and Association with Popliteal Fossa (Baker's) Cysts in Patients with Lower Extremity Duplex Ultrasound Examination

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-10
Author(s):  
Danielle Vlazny ◽  
Damon E. Houghton ◽  
Ryan Meverden ◽  
Paul Daniels ◽  
Matthew Bartlett ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Sensitivity And Specificity ◽  
Mayo Clinic ◽  
Duplex Ultrasound ◽  
Popliteal Fossa ◽  
Popliteal Vein ◽  
Vein Thrombosis ◽  
Radiology Reports ◽  
Deep Vein

Background: Popliteal fossa cysts (PFCs aka Baker's cysts) are synovial cysts of the knee joint that can be symptomatic or asymptomatic and incidentally identified on ultrasound. Whether PFCs are associated with deep vein thrombosis (DVT) is unknown. Possible mechanisms for an association include direct compression of the popliteal vein, indirect compression on the popliteal vein with leg flexion, adjacent inflammation of the cyst, or relative immobility due to underlying joint disease itself. Methods: Lower extremity venous Duplex ultrasound radiology reports from the inception of electronic archiving through 11/14/2019 were evaluated across the Mayo Clinic Enterprise (Rochester MN, Jacksonville, FL, Scottsdale AZ, and Mayo Clinic Health System) in patients &gt;18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute DVT (proximal or distal) and PFCs. A random sample of 1,752 ultrasound reports underwent manual review to calculate the sensitivity and specificity of the NLP algorithm. Cases (ultrasounds with acute DVT) were compared to controls (ultrasound without acute DVT) to examine the frequency of PFCs. IRB approval was obtained and patients lacking Minnesota research authorization were excluded. Results: A total of 332,016 lower extremity venous ultrasounds were performed in 223,035 patients; 156,846 unilateral and 175,170 bilateral lower extremities exams. The mean age at ultrasound was 63.3 (SD 16.5) and 54.7% were female. Ultrasound reports were available for analysis starting in 1992 with a significant increase in the number of ultrasounds performed over the study period across the enterprise (Figure 1). Overall, acute DVT was identified in 24,179 (7.3%) of ultrasounds, and PFCs were identified in 32,427 (9.8%) of ultrasounds. The sensitivity and specificity of the NLP algorithm in the full dataset to identify acute DVT was 86.0% and 97.2%, respectfully. The sensitivity and specificity of the NLP algorithm to identify PFCs was 97.8% and 99.5%, respectively. PFCs were present in 9.3% of ultrasounds with acute DVT and 9.8% of ultrasounds without acute DVT (p=0.007), OR 0.94 (95% CI 0.90-0.98). In a multivariate logistic regression model, after adjusting for age and sex, results remained significant (aOR 0.95, 95% CI 0.91-0.995). Comparing ultrasounds before and after 2010, there was a higher percentage of PFCs and acute DVT reported after 2010 (p&lt;0.001 for both). Sensitivity analyses comparing results before or after 2010, by sex, and only in the first ultrasound performed per person, demonstrated similar results. Conclusions: PFCs are negatively associated with the presence of acute DVT on lower extremity venous Duplex ultrasound. This data does not support PFCs as a contributing or causative factor in the development of lower extremity DVT. Figure 1 Disclosures No relevant conflicts of interest to declare.

Repeat duplex ultrasound scanning in suspected Deep Vein Thrombosis (DVT): putting the onus back on the referring clinician

2016 ◽  
Vol 15 (2) ◽  
pp. 63-67
Author(s):  
Bryan Renton ◽  
S Thiru ◽  
CP Griffin
Keyword(s):  
Deep Vein Thrombosis ◽  
Duplex Ultrasound ◽  
Ultrasound Scanning ◽  
Nice Guideline ◽  
Vein Thrombosis ◽  
Dramatic Rise ◽  
Wells Score ◽  
Deep Vein ◽  
Repeat Scanning ◽  
D Dimer

Duplex scanning is utilised by many departments in the investigation of suspected Deep Vein Thrombosis (DVT). NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was ‘likely’ in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome.

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

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.

Combining clinical risk with D-dimer testing to rule out deep vein thrombosis

2004 ◽  
Vol 27 (3) ◽  
pp. 233-239 ◽  
Author(s):  
Kaveh Ilkhanipour ◽  
Allan B. Wolfson ◽  
Heather Walker ◽  
Jason Cillo ◽  
Susan Rolniak ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Clinical Risk ◽  
Deep Vein ◽  
D Dimer ◽  
Rule Out

Risk Assessment Model to Predict Recurrence in Patients with Unprovoked Deep Vein Thrombosis or Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 452-452
Author(s):  
Sabine Eichinger ◽  
Georg Heinze ◽  
Paul Alexander Kyrle
Keyword(s):  
Risk Assessment ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Recurrence Risk ◽  
Assessment Model ◽  
Risk Scores ◽  
Risk Assessment Model ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Abstract 452 Background: Venous thrombosis is a chronic and potentially fatal disease (case fatality 5-9%). Predicting the likelihood of recurrence is important, as most recurrences can be prevented by antithrombotic therapy, albeit at the price of an increased bleeding risk during anticoagulation. Despite a substantial progress in identifying the determinants of the recurrence risk, predicting recurrence in an individual patient is often not feasible. Venous thromboembolism (VTE) is a multicausal disease and the combined effect of clinical and laboratory factors on the recurrence risk is unknown. It was the aim of our study to develop a simple risk model that improves prediction of the recurrence risk in patients with unprovoked VTE. Methods and Findings: In a prospective multicenter cohort study we followed 929 patients with a first VTE after completion of at least 3 months of anticoagulation. The median observation time was 43.3 months. Patients with VTE provoked by surgery, trauma, cancer, pregnancy or oral contraceptive intake were excluded as were those with a natural inhibitor deficiency or the lupus anticoagulant. The main outcome measure was symptomatic recurrent VTE, which occurred in 176 patients. The probability of recurrence (95% CI) after 2, 5 and 10 years was 13.8% (11.6% to16.5%), 24.6% (21.6% to 28.9%), and 31.8% (27.6% to 37.4%), respectively. To develop a simple and easy to apply risk assessment model, clinical and laboratory variables (age, sex, location of VTE, body mass index, factor V Leiden, prothrombin G20210A mutation, D-Dimer, in vitro thrombin generation) were preselected based on their established relevance for the recurrence risk, simple assessment, and reproducibility. All variables were analyzed in a Cox proportional hazards model, and those significantly associated with recurrence were used to compute risk scores. Only male sex [HR vs. female 1.90 (95% CI 1.31–2.75)], proximal deep vein thrombosis [HR vs. distal 2.08 (95% CI 1.16–3.74)], pulmonary embolism [HR vs. distal thrombosis 2.60 (95% CI 1.49– 4.53)] and elevated levels of D-Dimer [HR per doubling 1.27 (95% CI 1.08–1.51)] or peak thrombin [HR per 100 nM increase 1.38 (95% CI 1.17–1.63)] were related to a higher recurrence risk. We developed a nomogram (Fig. 1) based on sex, location of initial thrombosis, and D-Dimer that can be used to calculate risk scores and to estimate the cumulative probabilities of recurrence in an individual patient. The model has undergone extensive validation by a cross-validation process. The cohort was divided into test and validation samples thereby mimicking independent validation. This process was repeated 1000 times and the results were averaged to avoid dependence of the validation results on a particular partition of our cohort. Patients were assigned to different risk categories according to their risk score, which corresponded well with the recurrence rate as patients with lower scores had lower recurrence rates. Conclusion: By use of a simple scoring system the assessment of the recurrence risk in patients with a first unprovoked VTE can be improved in routine care. Patients with unprovoked VTE in whom the recurrence risk is low enough to consider a limited duration of anticoagulation, can be identified. Disclosures: No relevant conflicts of interest to declare.

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

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.

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

2021 ◽  
Vol 74 (4) ◽  
pp. e395
Author(s):  
Kristin Schafer ◽  
Eric Goldschmidt ◽  
Drew Oostra ◽  
Fedor Lurie
Keyword(s):  
Deep Vein Thrombosis ◽  
Risk Stratification ◽  
Lower Extremity ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Deep Vein ◽  
D Dimer
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