Ultrasonography often is performed ...

Ultrasonography often is performed to evaluate patients with suspected astute venous thrombosis (DVT) of the leg Simplified compression ultrasonography has high accuracy for symptomatic proximal venous thrombosis unless can miss thrombosis of the distal calf veins. A repeat simplified compression ultrasonography is necessary within five to seven days to expect for proximal thrombus propagation. Comprehensive duplex ultrasonography examines the profound veins within the entire leg down to the malleolus, thus potentially obviating routine repeat scanning. Steven and associates performed a prospective cohort close attention of patients with a suspected first episode of DVT who had a negative comprehensive leg duplex ultrasonogram.

The researchers examined the rate of venous thromboembolism in these patients after withholding anticoagulant therapy for three month Exclusion criteria included previous DVT pregnancy, and patients receiving long-term anticoagulation therapy for another reason. Comprehensive ultra-sonography was performed through registered vascular technologists and interpreted from a vascular surgeon. If a single, noncompressible portion was identified, the study was reported as positive, and the patient was diagnosed with DVT If the originates of all imaged venous parts were negative, anti- coagulation was withheld without consideration of symptoms or clinical signs.

Patients in the negative cohort were inter-viewed about multiple aspects of their health at least three month after enrollment in the cogitation The primary outcome measure was venous thromboembolism diagnosed according to objective testing, including death caused from a venous thromboembolism.

During the three-month period, symptoms of intermittent venous thromboembolism occurred in 22 of the 375 patients in the negative cohort, with three patients actually having objective evidence of symptomatic venous thrombosis (080 percent) Among the other 19 patients, four had suspected pulmonary embolism that was not con-firmed through objective testing. Six patients in the negative cohort died in the three-month follow-up period; none of the deaths were caused by means of venous thromboembolism.

The authors finish that although comprehensive duplex ultrasonography takes more time to perform than simplified comression ultrasonogaphy, the advantage of requiring single a single examination is significant. They state that it is safe to with-hold anticoagulation from patients with suspected symptomatic DVT who have a negative comprehensive duplex sonogram, repeatedly negative simplified compression ultrasonograms, or undivided negative simplified duplex ultrasonogram and normal eventuates on a whole blood D-dimer trial When comprehensive ultrasonography reveals thrombosis isolated to the calf vein, anticoagulation can be withheld if ultrasonography is repeated to monitor extension of these thrombi into proximal intelligent veins. The authors add that these terminates may not apply to patients who are pregnant or if factors hinder visualization of the deep venous a whole of the calf.

In an accompanying editorial, El Kheir and Buller confirm the value of the single comprehensive ultrasonogram approach and commend further testing of this process with good pretest clinical probability analysis or D-dimer testing to find the optimal algorithm to evaluate patients for symptomatic DVT

Steven SM et al. Withholding anticoagulation after a negative come on duplex ultrasonography for suspected symptomatic penetrating venous thrombosis. Ann Intern M June 15 2004;140:985-91 and El Kheir D Buller H One-time comprehensive ultrasonography to diagnose astute venous thrombosis: is that the solution? [Editorial] Ann Intern M June 15 2004;140:1052-3

COPYRIGHT 2005 American Academy of Family Physicians

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