The Diagnostic Value of Compression Ultrasonography in Patients with Suspected Recurrent Deep Vein Thrombosis
Paolo Prandoni (1), Anthonie WA Lensing (2), Enrico Bernardi (1), Sabina Villalta (1), Paola Bagatella (1), Antonio Girolami (1) for the DERECUS Investigators Group
(1) Department of Medical and Surgical Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Padua, Italy; (2) The Center for Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
Diagnosis of recurrent deep-vein thrombosis (DVT) is difficult
because of limitations in distinguishing acute from old thrombi. In the
past, an ultrasound method for diagnosis of recurrent ipsilateral DVT
was developed, which relies on repeated measurements of the diameters
of the common femoral and popliteal veins. To assess the safety
of withholding anticoagulation from patients with improved or stable
compression vein diameters, 205 consecutive patients presenting with
suspected recurrent ipsilateral DVT were evaluated. The vein diameter
was measured under compression with the transducer and compared
with earlier ultrasound results. Patients with stable or improved ultrasound
findings had repeat ultrasound assessments after 2 (± 1) and
7 (± 1) days. Patients with repeatedly normal ultrasound results were
followed-up for six months to determine the incidence of symptomatic
recurrent venous thromboembolism.
Of the 205 patients, 153 had stable or improved ultrasound findings.
Repeat ultrasound assessment became abnormal in 3, and recurrence
was confirmed by venography in all. A six months follow-up was
done in the remaining 150 patients with repeatedly normal ultrasound
tests and showed 2 (1.3%; 95% CI, 0.02 to 4.7%) confirmed non-fatal
venous thromboembolic complications. The positive predictive value
of a stable or improved ultrasound was 90% (95% CI, 77 to 97%).
In conclusion, it is safe to withhold anticoagulant treatment from patients
with suspected recurrent ipsilateral DVT in whom compression
ultrasonography showed improved or stable vein diameters.