Clinical Diagnosis Of Deep Venous Thrombosis Research Articles

Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D-Dimer Combined with RAPT Score Among Orthopedic Trauma Patients.

Among the causes of mortality in patients with lower extremity fracture following surgery, lower extremity deep venous thrombosis (DVT) is a leading one. To lower the morbidity and mortality, early screening and preventive anticoagulation therapy are essential in clinical study. Common screening methods, including risk prediction tools, imaging tests and D-dimer test, had various drawbacks. The study aimed to establish a new method, that is, D-dimer combined with Risk Assessment and Predictor Tool (RAPT) score, for screening the lower extremity DVT among patients with lower extremity fracture and evaluate its clinical value. The RAPT score, plasma D-dimer and lower extremity venous ultrasonography examination reports were collected from Department of Emergency Surgery & Orthopaedic Surgery from July 2019 to December 2019, and the data were analyzed retrospectively. Regarding the lower extremity venous ultrasonography examination report as the "gold standard" to determine whether DVT exists, the sensitivity, specificity and area under the curve (AUC) of RAPT score alone, plasma D-dimer alone and combination of them in screening lower extremity DVT were analyzed and evaluated. 197 patients were enrolled in the study. There were significant differences in D-dimer level and RAPT score between DVT group and non-DVT group (P < 0.01). The sensitivity, specificity and AUC of RAPT score and D-dimer in screening lower extremity DVT were 78.12%, 56.44%, 0.723 and 97.71%, 25.74%, 0.803, respectively. The optimal diagnostic value of D-dimer decided by Youden's index was 1.125μg/ml. The sensitivity and specificity of the method by combining RAPT score with this new D-dimer threshold were 96.88% and 42.57%, respectively, and AUC was 0.812. Higher diagnostic accuracy could be achieved by combining RAPT score with new D-dimer threshold. This novel diagnostic method is potential in the clinical diagnosis of DVT among orthopedic trauma patients.

Suspected Acute Deep Vein Thrombosis of the Lower Limb in Outpatients: Considerations for Optimal Diagnostic Approach

The objective of this study was to review our diagnostic approach using color duplex scanning (CDS) in the management of symptomatic outpatients with suspected lower limb deep venous thrombosis (DVT). CDS was carried out in 315 consecutive outpatients with unilateral symptoms consistent with DVT. Both limbs were assessed in 205 patients. Other pathology was routinely sought when the symptomatic limb was free of thrombosis. Acute DVT was present in 25% (76/315) of the symptomatic limbs, and in only 8% it was confined to calf veins. Other pathology was detected in 90 limbs (28%). Swelling with or without pain was associated with DVT in 44% and 10%, respectively. The time elapsed between the onset of symptoms and CDS was 3 days (range 1-6 days). DVT in the contralateral asymptomatic limb was present in 5 (9%) of the 56 patients with DVT in the symptomatic limb. In the absence of DVT in the symptomatic limb, the contralateral asymptomatic limb was free of thrombosis. Clinical diagnosis of DVT in outpatients was unreliable. CDS revealed that only one-fourth of the symptomatic limbs had DVT, and other pathology mimicking DVT was present in 28%. CDS is a useful tool that offers a prompt, efficient diagnosis. Investigation of the contralateral asymptomatic limb seems to be necessary only when DVT is found in the symptomatic limb.

Radiolabeled peptides in the detection of deep venous thrombosis

Venous thrombosis and pulmonary embolism are major clinical problems that result in significant morbidity and mortality. It is estimated that 600,000 cases of pulmonary embolism occur each year in the United States, resulting in the death of approximately 100,000 patients. Most of these pulmonary emboli arise from deep venous thrombosis (DVT). The clinical diagnosis of DVT is unreliable. Only a third of patients with a clinical suspicion of DVT have objective evidence of the disease, and half of patients with proven DVT do not have any clinical symptoms. Although ascending contrast venography is the present standard for the diagnosis of DVT, duplex ultrasonography, which is increasingly used in combination with color Doppler flow imaging, is accepted as a useful clinical afternative to contrast venography. Both contrast venography and ultrasonography are imaging procedures that detect changes in venous anatomy that are caused by the presence of an intraluminal thrombus that is sufficiently formed either to reduce vascular filling with contrast medium or to resist compression. However, these imaging procedures do not reflect the metabolic activity of the clot, and therefore, they may overestimate the presence of active clots. The sensitivity of ultrasonography is also limited by various disease-related and technical factors. An alternative approach to the diagnosis of acute DVT is to detect a molecular marker of acute DVT that is not present in old, organized DVT. Recent advances in biotechnology permit the use of highly specific synthetic peptide or small molecular markers, which are involved in the acute stages of DVT formation and can be labeled efficiently with 99mTc. 99mTc-apcitide, a glycoprotein (GP IIb/IIIa) receptor antagonist previously known as 99mTc-P280, has been approved recently by the Food and Drug Administration for the clinical detection of acute DVT. Two other agents are currently under clinical investigation: 99mTc-DMP 444, which is another GP IIb/IIIa receptor antagonist, and 99mTc-Fibrin-Binding Domain (FBD), a radio-labeled fibrin-binding domain of fibronectin. Different clinical studies have shown a high diagnostic accuracy with these synthetic 99mTc-labeled peptides in the detection of acute DVT. Although further studies are needed to fully appreciate all of the diagnostic potential of these radiopharmaceuticals, the clinical introduction of 99mTcapcitide scintigraphy will certainly be helpful in expanding the use of nuclear medicine in a specific field in which it used to play a relatively marginal role.

Duplex ultrasonographic findings in patients with suspected DVT

To highlight the usefulness of duplex ultrasonography in assessing patients with clinical features suggestive of DVT in this environment. A total of seventy patients (44 males and 26 females, aged 15-85 years) with a clinical diagnosis of deep venous thrombosis (DVT) were seen between September 2005 and September 2007 in the Radiodiagnosis Department of the Lagos University Teaching Hospital, and a private Multi-specialist hospital both in Lagos, Nigeria. They had bilateral lower extremity venous duplex ultrasonographic examination performed on them. The common femoral vein, superficial femoral vein, proximal deep femoral vein, proximal greater saphenous vein, popliteal vein and posterior tibial veins were evaluated with compression sonography in the transverse plane. Grey scale, colour and pulsed Doppler imaging of the venous segments were observed. The sonographic abnormalities observed included frozen valves, venous reflux, venous dilatation with echogenic thrombus, absence of Doppler signals and narrowed, thick walled veins. It was observed that 30 (42.3%) patients had acute DVT, 11 (15.7%) had chronic venous disease (CVD), while 10 (14.3%) had incompetence of the superficial venous system. Acute DVT was the commonest pathology observed. Duplex ultrasonography should be performed on all patients with a clinical diagnosis of DVT in order to rule out other differential diagnoses.