Role of Interventions in Acute Lower Limb Deep Venous Thrombosis: Current Options

Aim: To review the role of compression treatments in the prevention of perioperative deep venous thrombosis. Method: A review of current literature in the field of prevention of deep venous thrombosis following general and orthopaedic surgery has been conducted. Synthesis: There is a considerable risk of deep venous thrombosis following surgical treatment in hospital. This is particularly high following joint replacement in the lower limb. This may lead to fatal pulmonary embolism or chronic venous insufficiency of the lower limb with leg ulceration and disability. Perioperative deep venous thrombosis may be prevented by a number of drugs. The most frequently used is heparin or the more modern low-molecular-weight heparins (LMWH). Vitamin K antagonists are also commonly used, but have a long duration of action. Dextrans and aspirin have an effect in preventing perioperative venous thrombosis, but this is much less than heparin. Mechanical methods of prevention have the advantage of preventing venous thrombosis without increased risk of bleeding complications. Conclusion: Heparin and LMWH continue to be the most frequently used means of preventing peri-operative deep venous thrombosis in France. There is reliable to evidence to show that mechanical methods of prevention including graduated elastic compression and intermittent pneumatic compression of the lower limb are also effective. These may be used in combination with heparin for increased protection or as an alternative to anticoagulant drugs where there is a risk of bleeding. They are also effective when used alone.

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Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651178 ◽

1993 ◽

Vol 69 (01) ◽

pp. 008-011 ◽

Cited By ~ 22

Author(s):

Cedric J Carter ◽

D Lynn Doyle ◽

Nigel Dawson ◽

Shauna Fowler ◽

Dana V Devine

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Utility ◽

Rapid Test ◽

Fibrin Degradation Product ◽

Current Form ◽

Non Invasive ◽

Clinically Significant ◽

D Dimer

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

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Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound

ISRN Radiology ◽

10.1155/2014/519875 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Maryam Rahiminejad ◽

Anshul Rastogi ◽

Shirish Prabhudesai ◽

David Mcclinton ◽

Peter MacCallum ◽

...

Keyword(s):

Risk Factor ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Risk Factor ◽

Diagnostic Pathway ◽

Clinical Diagnostic ◽

Retrospective Audit ◽

Wells Score ◽

D Dimer

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

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Role of MR venography in the evaluation of deep venous thrombosis

Acta Radiologica ◽

10.1080/02841859709172434 ◽

1997 ◽

Vol 38 (5) ◽

pp. 907-912 ◽

Cited By ~ 25

Author(s):

C. Catalano ◽

P. Pavone ◽

A. Laghi ◽

A. Scipioni ◽

F. Fanelli ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Sensitivity And Specificity ◽

Filling Defect ◽

Clinical Suspicion ◽

Mr Venography ◽

Diagnostic Modalities ◽

Positive Results ◽

Intraluminal Filling Defect

Purpose: MR venography has been recommended for the evaluation of deep venous thrombosis. The purpose of our study was to determine the role of MR venography, in particular at the level of the pelvis where other diagnostic modalities show major limitations. Materials and Methods: Forty-three patients with clinical suspicion of deep venous thrombosis were examined by means of pelvic MR venography. In all cases, a 2D-TOF sequence was used with cranial arterial presaturation. In selected cases, i.e. when a small intraluminal filling defect was present, a cine-PC sequence was used in addition in order to exclude the presence of a pulsatility artifact as causing the filling defect. In all cases, contrast venography was also performed and considered to be the standard of reference. Results: MR venography showed 26 patients to be positive for deep venous thrombosis at the pelvic level. These positive results were correct in 25 cases. The analysis of the results provided values of sensitivity and specificity of respectively 100% and 94%, with an overall accuracy of 97.6%. Conclusion: Our results indicate that MR can provide highly accurate images, similar to those of contrast venography, in a noninvasive fashion. It is particularly useful in the pelvic region where the limitations of other imaging modalities are more evident.

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Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

CardioVascular and Interventional Radiology ◽

10.1007/s00270-012-0342-z ◽

2012 ◽

Vol 35 (6) ◽

pp. 1408-1413 ◽

Cited By ~ 45

Author(s):

Mohsen Sharifi ◽

Curt Bay ◽

Laura Skrocki ◽

David Lawson ◽

Shahnaz Mazdeh

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intervention Trial ◽

Thromboembolic Risk ◽

Ivc Filters

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Duplex doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities

Medicinski pregled ◽

10.2298/mpns0602011v ◽

2006 ◽

Vol 59 (1-2) ◽

pp. 11-14 ◽

Cited By ~ 2

Author(s):

Viktorija Vucaj-Cirilovic ◽

Kosta Petrovic ◽

Olivera Nikolic ◽

Viktor Till ◽

Dijana Niciforovic ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Doppler Ultrasonography ◽

Varicose Veins ◽

Color Doppler ◽

Lower Extremities ◽

Postthrombotic Syndrome ◽

Duplex Doppler ◽

Age Range

Introduction. The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. Material and methods. During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619(72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro color doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. Results. 185 (21%) patients had DVT, 366 (42.5%) patients had pre?dominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. Conclusions. Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy. .

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