Abstract
The diagnosis and management of an acute DVT is difficult and mistakes are often made. The cost to the National Health Service (NHS) of litigation arising from failure to diagnose and treat DVT early is substantial. Clinical diagnosis alone is often unreliable and a large proportion of DVT occurring in hospital are asymptomatic. In the United Kingdom, clinical scoring systems, D-dimer and ultrasound (US) imaging have all been adopted to aid diagnosis via DVT pathways. These pathways aim to exclude DVT only and often fail to actually address the cause of the symptoms once DVT is eventually cleared.
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References
Bernardi E, Camporese G, Buller HR, Siragusa S, Imberti D, Berchio A et al (2008) Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA 300(14):1653–1659
Brandjes DP, Buller HR, Heijboer H, Huisman MV, de Rijk M, Jagt H et al (1997) Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 349(9054):759–762
Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W et al (2012) Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 379(9810):31–38
Eriksson BI, Quinlan DJ (2006) Oral anticoagulants in development: focus on thromboprophylaxis in patients undergoing orthopaedic surgery. Drugs 66(11):1411–1429
Frankel DA, Bundens WP (2014) Diagnosis of deep vein thrombosis. In: The vein book. Oxford University Press, Oxford
Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 136(2):89–98
Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A (2005) Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 5:6
Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR et al (2014) Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 383(9920):880–888
Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ (2008) Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl):454S–545S
Khanbhai M, Hansrani V, Burke J, Ghosh J, McCollum C (2015) The early management of DVT in the North West of England: a nation-wide problem? Thromb Res 136(1):76–86
Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A et al (2006) D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 355(17):1780–1789
Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A et al (2014) D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. Blood 124(2):196–203
Partsch H (2005) Immediate ambulation and leg compression in the treatment of deep vein thrombosis. Dis Mon 51(2–3):135–140
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism. National Institute of Health and Care Excellence, technology appraisal guidance 261 (online). http://www.nice.org.uk/guidance/ta261. Accessed 9 May 2015
Robinson KS, Anderson DR, Gross M, Petrie D, Leighton R, Stanish W et al (1998) Accuracy of screening compression ultrasonography and clinical examination for the diagnosis of deep vein thrombosis after total hip or knee arthroplasty. Can J Surg 41(5):368–373
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962
Sarrazin MS (2015) Safety of new oral anticoagulants. BMJ 350:h1679
Schumann SA, Ewigman B (2007) Is it DVT? Wells score and D-dimer may avert costly workup. J Fam Pract 56(12):1010–1012
Spritzer CE, Arata MA, Freed KS (2001) Isolated pelvic deep venous thrombosis: relative frequency as detected with MR imaging. Radiology 219(2):521–525
Treating venous thromboembolism. National Institute of Health and Care Excellence pathways, June 2012. (Online). http://pathways.nice.org.uk/pathways/venous-thromboembolism/treating-venous-thromboembolism. Accessed 10 May 2015
Venous thromboembolic disease: the management of venous thromboembolic disease and the role of thrombophilia testing. National Institute of Health and Care Excellence, June 2012. (Online). http://www.nice.org.uk/guidance/cg144. Accessed 14 May 2015
Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J et al (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 349(13):1227–1235
Yoshimura N, Hori Y, Horii Y, Takano T, Ishikawa H, Aoyama H (2012) Where is the most common site of DVT? Evaluation by CT venography. Jpn J Radiol 30(5):393–397
Zierler BK (2004) Ultrasonography and diagnosis of venous thromboembolism. Circulation 109(12 Suppl 1):I9–I14
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Hansrani, V., Khanbhai, M., McCollum, C. (2016). The Diagnosis and Management of Early Deep Vein Thrombosis. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_103
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DOI: https://doi.org/10.1007/5584_2016_103
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