Diagnosis Of Recurrent Deep Vein Thrombosis Research Articles

Abstract 16: FDG-PET/CT Enables the Detection of Recurrent, Same-Site Deep Vein Thrombosis by Illuminating Recently Formed Neutrophil-Rich Thrombus

Background: Specific detection of recurrent deep vein thrombosis (DVT) is a challenging clinical problem. As DVT formation and resolution are inflammatory processes, we experimentally investigated whether noninvasive 18F-fluorodeoxyglucose (FDG)-PET imaging could identify inflamed, recently formed thrombi and thereby improve the diagnosis of recurrent DVT. Methods: We established a stasis-induced DVT model in murine jugular veins and also a novel model of recurrent stasis DVT in mice. C57BL/6 mice (n = 30) underwent ligation of the jugular vein to induce stasis DVT. FDG-PET/CT was performed at DVT timepoints of day 2, 4, 7, 14, or 2+16 (same-site recurrent day 2 DVT overlying a 16 days old DVT). Antibody-based neutrophil depletion was performed in a subset of mice prior to DVT formation and FDG-PET/CT. In a clinical study, 38 patients with lower extremity DVT or controls undergoing FDG-PET were retrospectively analyzed. Results: Stasis DVT demonstrated that the highest FDG signal occurred day 2, followed by a time-dependent decrease (p<0.05). Histological analyses demonstrated that thrombus neutrophils (p<0.01), but not macrophages, correlated with thrombus PET signal intensity. Neutrophil depletion decreased FDG signals in day 2 DVT compared to that of control mice (p<0.05). Recurrent DVT demonstrated significantly higher FDG uptake than organized day 14 DVT (p<0.05). The FDG DVT signal in patients also exhibited a time-dependent decrease (p<0.05). Recurrent day 2 DVT showed neutrophil-dominant infiltration pattern with few macrophages, similar to standalone day 2 DVT. Conclusions: Noninvasive FDG-PET/CT identifies neutrophil-dependent thrombus inflammation in murine DVT, and demonstrates a time-dependent signal in both murine and clinical DVT. FDG-PET/CT may offer a molecular imaging strategy to accurately diagnose recurrent DVT.

Magnetic resonance imaging and computed tomography developments in imaging of venous thromboembolism

Venous thromboembolism (VTE) is a disease that causes high morbidity and mortality in the population. At present the first-line imaging test for a suspected pulmonary embolism (PE) is computed tomography (CT) pulmonary angiography, and ultrasonography is widely used for the diagnosis of deep-vein thrombosis (DVT). Although these modalities are proven to be safe and accurate, unresolved issues remain, such as whether CT scanning in patients with a suspected PE should be extended to the legs. Another issue is the diagnosis of recurrent DVT. Magnetic resonance imaging (MRI) offers a number of advantages in the imaging of VTE. Recent developments of scanning protocols with shorter acquisition times, sometimes complemented by navigator gating or making use of endogenous contrast, offer new perspectives for the use of MRI. This review provides an overview of state of the art MRI techniques for the diagnosis of PE and DVT. Furthermore, the use of new contrast agents such as fibrin labeling to detect thrombi are addressed.

Ranitidine-Warfarin Interaction

Letters and Corrections1 January 1990Ranitidine-Warfarin InteractionAnne M. Baciewicz, PharmD, Peter J. Morgan, MDAnne M. Baciewicz, PharmDSearch for more papers by this author, Peter J. Morgan, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-1-76_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:We report a possible prolongation of prothrombin time (PT) of warfarin by ranitidine. A 65-year-old woman with a past medical history of a cerebral vascular accident and an aortic valve replacement was discharged from the hospital with a diagnosis of recurrent deep-vein thrombosis, recurrent gastrointestinal bleeding, and iron-deficiency anemia. Four days before discharge, the ranitidine dose was increased to 600 mg daily because on the recommended 300-mg daily maintenance dose for several months the patient developed recurrent gastrointestinal bleeding. At discharge, her medications (all taken orally) included warfarin, 5 mg once daily; ranitidine, 300 mg twice daily;...

Clinical Utility of Impedance Plethysmography in the Diagnosis of Recurrent Deep-Vein Thrombosis

The last decade has witnessed a marked change in the attitude of physicians to the diagnosis of venous thrombosis. The early observation made by Haeger 1 of the nonspecificity of clinical diagnosis has been confirmed repeatedly 2-4 and it is no longer acceptable to make management decisions on clinical diagnosis alone. Venography, the diagnostic standard, is now safer and more reliable because of improved standards of technique and interpretation. 5,6 Nevertheless, venography has limitations. It is invasive, it cannot be performed conveniently in an outpatient setting, and it requires the services of an experienced radiologist; even then, approximately 15% of venograms are technically inadequate. For these reasons, and the additional reason of the cost of unnecessary hospital admissions, there has been increasing interest in the development and application of noninvasive techniques that can be performed at the patient's bedside or in an emergency room. A number See also p 681.

Utility of Impedance Plethysmography in the Diagnosis of Recurrent Deep-Vein Thrombosis

Serial impedance plethysmography has been shown to be a safe and effective alternative to venography in the management of patients with clinically suspected acute venous thrombosis. The rate of normalization of an initial abnormal impedance plethysmogram and, consequently, the usefulness of impedance plethysmography in the management of patients with recurrent symptoms is, however, unknown. In a prospective cohort follow-up study, 161 consecutive patients with proved venous thrombosis and abnormal impedance plethysmograms were studied for one year. After 3, 6, 9, and 12 months, the impedance plethysmograms had normalized in 67%, 85%, 92%, and 95% of the patients, respectively. Thirty-five patients (22%) returned with clinically suspected recurrent thrombosis, of whom 31 had normal impedance plethysmograms prior to their return. In 18 of these patients, repeated tests were normal; these patients did not undergo anticoagulant therapy, and follow-up disclosed no subsequent adverse consequences. In the other 13 patients, the test again became abnormal; 11 patients were shown by venograms to have recurrent deep-vein thrombosis. Consequently, 29 (83%) of the 35 patients in whom the suspicion of recurrent thrombosis arose could have been managed with impedance plethysmography alone without the necessity for venography or anticoagulant therapy. It is concluded that normalization of impedance plethysmography tests occurs in almost all patients within nine months, and that serial impedance plethysmography is useful for patient management in nearly 90% of patients presenting with recurrent symptoms.

Clinical utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis

Clinical utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis

Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis

Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis