Materiały źródłowe

• #1 Diagnosis, investigation, and management of deep vein thrombosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1126050/

  Deep vein thrombosis is an important cause of morbidity and mortality worldwide, and its clinical diagnosis is unreliable. This article explains current screening and diagnostic methods as well as treatment. […] No single investigation for the diagnosis of deep vein thrombosis has ideal properties (100% sensitivity and specificity, low cost, no risk), and often several tests are performed, either sequentially or in combination. […] Clinical diagnosis is unreliable. […] Definitive diagnosis is usually by venography or ultrasonography. […] The clinical diagnosis of deep vein thrombosis of the lower limb is unreliable. Individual signs and symptoms are of little value, and Homan’s sign is of no value. […] The search has been continuing for a screening test with a high negative predictive value, which can be used as a rule-out test to reduce the need for imaging.

• #1 Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p913.html

  Venous thromboembolism manifests as deep venous thrombosis (DVT) or pulmonary embolism, and has a mortality rate of 6 to 12 percent. Well-validated clinical prediction rules are available to determine the pretest probability of DVT and pulmonary embolism. When the likelihood of DVT is low, a negative d-dimer assay result excludes DVT. Likewise, a low pretest probability with a negative d-dimer assay result excludes the diagnosis of pulmonary embolism. If the likelihood of DVT is intermediate to high, compression ultrasonography should be performed. Impedance plethysmography, contrast venography, and magnetic resonance venography are available to assess for DVT, but are not widely used. […] To provide prompt and accurate diagnosis, clinical prediction rules and diagnostic algorithms have been developed for VTE. A common approach is to use a validated prediction rule for risk stratification, screen with d-dimer assay as appropriate, and if necessary, perform the appropriate imaging studies to confirm or exclude VTE. This article reviews the diagnosis of pulmonary embolism and DVT.

• #2 Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p913.html

  In patients with a low pretest probability of DVT or pulmonary embolism, a negative result from a high-sensitivity d-dimer assay is sufficient to exclude venous thromboembolism. Validated clinical prediction rules can be used to estimate pretest probability of DVT and pulmonary embolism, and guide further evaluation. Compression ultrasonography should be the initial test for patients with intermediate to high pretest probability of DVT in the lower extremities. In patients with intermediate to high pretest probability of DVT, negative ultrasonography alone is insufficient to exclude the diagnosis of DVT. Further assessment is recommended, including checking the d-dimer level and repeating ultrasonography in one week if the d-dimer level is elevated. […] The classic clinical presentation of DVT includes swelling, pain, warmth, and redness in the involved extremity. Alternatively, DVT can occur asymptomatically. Individual symptoms are neither sensitive nor specific for DVT.

• #3 Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p913.html

  Several pretest probability scoring systems, such as the Hamilton score, the AMUSE (Amsterdam Maastricht Utrecht Study on thromboEmbolism) score, and the Wells clinical prediction rule, are available for DVT assessment. Among them, the Wells rule is perhaps the best known. It divides patients into low-, intermediate-, and high-risk categories. […] According to Figure 1, compression ultrasonography should be the initial test when the pretest probability of DVT is intermediate to high. Ultrasonography achieves its best sensitivity (89 to 96 percent) and specificity (94 to 99 percent) in symptomatic patients with proximal thrombosis of the lower extremities. In patients with intermediate to high pretest probability of DVT, a negative ultrasonography result alone is insufficient to exclude the diagnosis of DVT. Further assessment is recommended, including checking d-dimer level and repeating ultrasonography in one week if d-dimer level is elevated.

• #4 Diagnosis of Venous Thromboembolism – Clinical Practice Guideline | AAFP

  https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/venous-thromboembolism-diagnosis.html

  For individuals with a low pretest probability or prevalence, clinicians should use a D-dimer strategy to rule out DVT followed by proximal lower extremity ultrasound or whole-leg ultrasound in patients requiring additional testing. […] For individuals with low pretest probability or prevalence (10%), positive D-dimer alone should not be used to diagnose DVT and additional testing following negative proximal or whole-leg ultrasound should not be conducted. […] For individuals with an intermediate pretest probability or prevalence (~25%), whole-leg ultrasound or proximal lower extremity ultrasound should be used. Serial proximal ultrasound testing is needed after a negative proximal ultrasound. No serial testing is needed after a negative whole leg ultrasound. […] For individuals with suspected DVT and high pretest probability or prevalence (50%), whole-leg ultrasound or proximal lower extremity ultrasound should be used. Serial ultrasound should be used if initial ultrasound is negative and no alternative diagnosis is identified.

• #5 Diagnosis and Management of Acute Deep Vein Thrombosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/03/02/15/24/diagnosis-and-management-of-acute-deep-vein-thrombosis

  Diagnosis and Management of Acute Deep Vein Thrombosis […] The following are key points to remember from this joint consensus document from the European Society of Cardiology about the diagnosis and management of acute deep vein thrombosis (DVT): […] Clinical signs and symptoms of DVT are highly variable and nonspecific, but remain the cornerstone of diagnostic strategy. Symptoms include pain, swelling, increased skin vein visibility, erythema, and cyanosis accompanied by unexplained fever. […] […] Clinical prediction rule (two-level modified Wells score) is recommended to stratify patients with suspected lower limb DVT. […] […] Enzyme-linked immunosorbent assay (ELISA) D-dimer measurement is recommended in unlikely clinical probability patients to exclude DVT. […] […] Venous ultrasound (US) is recommended as the first-line imaging method for DVT diagnosis. Venous computed tomography (CT) scan should be reserved for selected patients only. Venous US should be proposed also in case of confirmed pulmonary embolism (PE), for initial reference venous imaging, useful in case of DVT recurrence suspicion, or further stratification in selected patients. […]

• #6 Deep vein thrombosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000112

  Deep vein thrombosis (DVT) is the development of a blood clot within a vein deep to the muscular tissue planes. […] Assessment of pre-test probability (using a validated score such as Wells) is key if DVT is suspected, and should be used in combination with an algorithmic diagnostic approach to avoid unnecessary imaging when the likelihood of DVT is low. […] Diagnosis requires confirmation of a blood clot in a deep vein in the leg, pelvis, or vena cava by venous ultrasound imaging (or other imaging techniques such as computed tomography scan). […] 1st investigations to order: quantitative D-dimer level, venous ultrasound, full blood count, urea and creatinine, liver function tests, clotting screen. […] Investigations to consider: CT/MRI venography, further investigation for unprovoked DVT.

• #7 Testing and Diagnosis for Venous Thromboembolism | Venous Thromboembolism (Blood Clots) | CDC

  https://www.cdc.gov/blood-clots/testing-diagnosis/index.html

  Your doctor must perform special tests to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE). […] Therefore, special tests that can look for clots in the veins or in the lungs (imaging tests) are needed to diagnose DVT or PE. […] Duplex ultrasonography is an imaging test that uses sound waves to look at the flow of blood in the veins. It can detect blockages or blood clots in the deep veins. It is the standard imaging test to diagnose DVT. […] A D-dimer blood test measures a substance in the blood that is released when a clot breaks up. If the D-dimer test is negative, it means that the patient probably does not have a blood clot. […] Contrast venography is a special type of X-ray where contrast material (dye) is injected into a large vein in the foot or ankle so that the doctor can see the deep veins in the leg and hip. It is the most accurate test for diagnosing blood clots but it is an invasive procedure, which means it is a medical test that requires doctors to use instruments to enter the body. Therefore this test has been largely replaced by duplex ultrasonography, and it is used only in certain patients.

• #8 Diagnosis, investigation, and management of deep vein thrombosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1126050/

  A fast, reliable, non-invasive, and inexpensive screening test is needed that can be performed immediately on attendance at hospital. […] Plasma d-dimers are specific cross linked derivatives of fibrin, produced when fibrin is degraded by plasmin, so concentrations are raised in patients with venous thromboembolism. […] Although sensitive for venous thromboembolism, high concentrations of d-dimers are insufficiently specific for making a positive diagnosis because they occur in other disorders such as malignancy and pregnancy and after operations. […] Investigations used for the definitive diagnosis of deep vein thrombosis visualise the thrombus. […] Ultrasonography is considered to be the best non-invasive diagnostic method and has been evaluated against venography in many studies, showing an average sensitivity and specificity of 97% for proximal deep vein thrombosis. […] The gold standard for establishing the diagnosis of deep vein thrombosis has been contrast venography.

• #9 Urgent Care Diagnosis and Management of Deep Vein Thrombosis – Journal of Urgent Care Medicine

  https://www.jucm.com/urgent-care-diagnosis-and-management-of-deep-vein-thrombosis/

  The Wells DVT risk score is a widely used and validated clinical decision tool used to help determine the pretest probability of DVT. […] The current recommendations favor a combined approach toward diagnosis: Patients with a score of 1 or less on the Wells criteria have a low risk of DVT, so this should prompt a D-dimer test which, if negative, can reliably exclude the diagnosis. […] D-dimer levels increase with age, leading to even lower specificity for DVT in older patients. An age-adjusted d-dimer threshold, defined as the patients age multiplied by 10 ng/mL, has been suggested for patients older than 50 years. […] In outpatient settings, the preferential diagnostic imaging choice should be venous compression ultrasound. […] The Wells score is applied, and this patient gets 1 point for her pain along the deep venous system. Based on this, the patient has moderate risk with a 17% pretest probability.

• #10 Deep Vein Thrombosis (DVT)

  https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt

  Deep vein thrombosis (DVT, also called venous thrombosis) occurs when a thrombus (blood clot) develops in veins deep in your body because your veins are injured or the blood flowing through them is too sluggish. […] A physician can diagnose superficial vein clots with a physical exam, they can only diagnose DVT with an ultrasound. […] Your healthcare provider will do a physical exam and review your medical history. You’ll also need to have imaging tests. […] Duplex venous ultrasound. This is the most common test for diagnosing a DVT because it is non-invasive and widely available. […] If the results of the duplex ultrasound aren’t clear, your provider can use another imaging test. […] Venography. In this invasive test, your provider numbs the skin of your neck or groin and uses a catheter to inject a special dye (contrast material) into your veins to see if any blood clots are partially or completely blocking blood flow inside your veins.

• #10 Deep Vein Thrombosis (DVT)

  https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt

  MRI shows pictures of organs and structures inside your body. MRV shows pictures of the veins in specific locations in your body. […] Your provider may use a CT scan to find a DVT in your abdomen, pelvis or brain, as well as blood clots in your lung (pulmonary embolism). […] If your doctor thinks you may have a genetic or acquired clotting disorder, you may need to have special blood tests.

• #11 Deep vein thrombosis diagnosis: What to know about DVT tests

  https://www.medicalnewstoday.com/articles/deep-vein-thrombosis-diagnosis

  Diagnosis for deep vein thrombosis (DVT) typically involves imaging tests. Following diagnosis, a doctor can advise on suitable treatments. […] Doctors may begin the evaluation of DVT by taking a medical history and performing a physical examination. If the initial assessment indicates potential DVT, they may request a series of tests to confirm the diagnosis or rule out other possible causes. […] Duplex ultrasonography, or duplex scan, is the standard imaging test for diagnosing DVT. It combines conventional ultrasound with Doppler ultrasound to use sound waves to examine blood flow in the veins. […] A D-dimer test can be the first step to look for signs of a blood clot. It measures a substance in the blood known as D-dimer that releases when fibrin, a protein that stops bleeding, dissolves.

• #12 Deep Venous Thrombosis (DVT) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt

  Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. […] Diagnosis is by history and physical examination and is confirmed by objective testing, typically with duplex ultrasonography. D-Dimer testing is sometimes used when DVT is suspected; a negative result helps to exclude DVT, whereas a positive result is nonspecific and requires additional testing to confirm DVT. […] Diagnosis is typically by ultrasonography with Doppler flow studies (duplex ultrasonography). The need for additional tests (eg, D-dimer testing) and their choice and sequence depend on pretest probability and sometimes ultrasonography results. […] Ultrasonography identifies thrombi by directly visualizing the venous lining and by demonstrating abnormal vein compressibility or, with Doppler flow studies, impaired venous flow. The test is 90% sensitive and 95% specific for femoral and popliteal vein thrombosis but is less accurate for iliac or calf vein thrombosis.

• #13 How is DVT diagnosed? – Blood Clots

  https://www.stoptheclot.org/learn_more/signs-and-symptoms-of-blood-clots/how_dvt_is_diagnosed/

  In the diagnosis of DVT, the physician considers the patients specific risk factors, the patients symptoms, the physical examination, other possible explanations for the symptoms, and the results of objective tests, such as some method of imaging or seeing the clot. […] The first diagnostic method that is usually performed to image or see the clot is ultrasoundspecifically, duplex ultrasound. […] If a vein cannot be compressed because a clot prevents the vein from collapsing, a DVT diagnosis is made. […] Absence of blood flow confirms the diagnosis of DVT. […] Duplex ultrasound successfully identifies 95 percent of deep vein thromboses that occur in the large veins above the knee. […] The ability of duplex ultrasound to detect DVT in the large veins above the knee is so good that when the test is positive, no further testing is necessary and treatment may be started.

• #14 How is DVT diagnosed? – Blood Clots

  https://www.stoptheclot.org/learn_more/signs-and-symptoms-of-blood-clots/how_dvt_is_diagnosed/

  Conversely, if the test is negative, the chance that there is a DVT is so small that treatment may safely be withheld. […] This technique is not as good at detecting DVT that occurs below the knee or in the calf veins, however. […] If the ultrasound is negative, yet the patients symptoms are severe or a DVT is strongly suspected, the next step is either a venogram (venography) or magnetic resonance imaging (MRI). […] Although isolated pelvic vein thrombosis is uncommon, it can occur in women who are pregnant or who have recently delivered a baby, in people who have had pelvic cancer, or in people who have had recent pelvic surgery. […] Today, the use of x-ray venography has been almost entirely replaced by the use of ultrasound and magnetic resonance (MR) venography, because x-ray venography is invasive and can be painful. […] Because clots give off different signals than flowing blood, MR can be used to detect a thrombosis. […] For that reason, a blood test for D-dimers is often performed to ensure that a blood clot is absent.

• #15 Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-024-00378-1

  The assessment of deep venous thrombosis (DVT) is clinically difficult diagnosis. The gold standard test for DVT diagnosis is venography; however, various point-of-care ultrasound (POCUS) protocols have been suggested for DVT evaluation in the emergency department. […] This review evaluated the role of different POCUS protocols in diagnosing DVT in the emergency department. […] The pooled sensitivity, specificity, PPV, and NPV for the 2-point POCUS protocol were 92.32% (95% CI: 87.58-97.06), 96.86% (95% CI: 95.09-98.64), 88.41% (95% CI: 82.24-94.58) and 97.25% (95% CI: 95.51-98.99), respectively. Similarly, the pooled sensitivity, specificity, PPV, and NPV for 3-point POCUS were 89.15% (95% CI: 83.24-95.07), 92.71% (95% CI: 89.59-95.83), 81.27% (95% CI: 73.79-88.75), and 95.47% (95% CI: 92.93-98). The data pooled for complete compression ultrasound, and whole-leg duplex ultrasound also resulted in a sensitivity and specificity of 100% (95% CI: 98.21-100) and 97.05% (95% CI: 92.25-100), respectively.

• #16 Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-024-00378-1

  The diagnostic performance of POCUS protocols performed by emergency physicians was excellent. Combined with the significant reduction in time to diagnosis. POCUS can be used as the first-line imaging tool for DVT diagnosis in the emergency department. […] The main aim of this systematic review and meta-analysis was to assess the diagnostic performance of POCUS protocols used to diagnose DVT and carried out in the emergency department (ED) or by emergency physicians (EP). […] The diagnostic results reported in our study are supported by a more recent meta-analysis that compared 2-point and 3-point POCUS and had fewer included studies than ours. The results of that meta-analysis showed high sensitivity and specificity for both 3-point (90% and 95%) and 2-point POCUS (91% and 98%). […] Our meta-analysis results have also shown that POCUS is advantageous in reducing the time from triage to DVT diagnosis compared to reference tests in the radiology department.

• #17 Diagnosis of deep vein thrombosis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/diagnosis-of-deep-vein-thrombosis.html

  Ultrasonography is now the first test for DVT. It can be used to diagnose proximal DVT or screen high-risk patients after surgery. […] Colour duplex ultrasonography allows direct visualisation of the deep veins and detection of venous flow. […] Diagnosis of DVT is based on: failure of the vein to compress, presence of a thrombus, absence of venous flow augmentation during compression of the calf. Non-compressibility of the vein is the most sensitive and specific feature of proximal DVT (95%). […] Until the mid 1980s, the diagnosis of DVT was largely dependent on venography. Although being replaced by ultrasonography, it is still regarded as the 'gold standard’ for diagnosing DVT. […] Venography may still have a role in diagnosing acute DVT in patients with recurrent thrombosis, screening for DVT in asymptomatic high-risk patients and diagnosing abdominal venous thrombosis.

• #18 Deep vein thrombosis: pathogenesis, diagnosis, and medical management – Stone – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/16872/html

  Other diagnostic imaging modalities used for DVT include conventional contrast venography, computed tomography (CT) venography, and magnetic resonance (MR) venography. […] Anticoagulation is an essential component of therapy for DVT. […] The treatment of DVT has traditionally included VKAs such as warfarin with heparin or fractionated heparin bridging. […] With the arrival of DOACs came hope for more therapeutic options for DVT, but the safety and efficacy profile of these newer agents compared to conventional therapy has been of paramount importance. […] DVT is diagnosed with increasing precision using the Wells criteria, D-dimer assay, and an expanding array of imaging modalities including US, CT, and MR venography.

• #19 Deep Vein Thrombosis (DVT) Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/deep-vein-thrombosis

  Other diagnostic tests may include: D-dimer blood test This test measures a substance that a blood clot releases when it breaks up. Computerized tomographic (CT) scan This imaging test uses cross-sectional x-rays and a computer to create detailed 3D images. Magnetic resonance imaging (MRI) MRI uses a large magnetic field, radio waves, and computers to create detailed images of your veins. […] Most patients will make a complete recovery after DVT treatment. However, some patients may develop a condition called post-thrombotic syndrome (PTS). PTS occurs due to damage to the vein and causes lingering symptoms similar to those caused by DVT. You may need to take blood-thinning medications to reduce your risk of future blood clots.

• #20 Deep Vein Thrombosis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/deep-vein-thrombosis-diagnosis/

  Deep vein thrombosis (DVT) is common, with over 45,000 cases diagnosed in Canada each year. […] Diagnosis of DVT requires determining the pre-test probability of DVT either through clinical gestalt (depends on clinical experience) or better to use a clinical tool, such as the Well’s Score followed by D-dimer/ultrasound as indicated. […] Thrombosis Canada recommends patients presenting with suspected DVT should be risk stratified. The most commonly used tool is the Well’s Score for DVT. […] Wells Score > 2: DVT Likely […] Perform Venous Compression Ultrasound (CUS) of the extremity […] CUS is positive, initiate appropriate treatment for DVT. […] CUS is negative, recommend performing a D-Dimer: […] D-Dimer is negative, DVT can be ruled out. […] D-Dimer is positive, repeat CUS in one week.

• #21 Deep Vein Thrombosis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/deep-vein-thrombosis-diagnosis/

  Wells Score < 2: DVT Unlikely [...] Perform a D-Dimer: [...] D-Dimer is negative, a DVT can be ruled out. [...] D-Dimer is positive, perform a CUS. [...] If the CUS is positive, a diagnosis of DVT can be made. [...] If the CUS is negative, DVT can be ruled out. [...] A D-dimer less than a fixed cut-off, in combination with validated clinical prediction rules (Wells score) can be used to rule out DVT in patients where DVT is deemed unlikely. [...] This diagnostic strategy has been approved and developed by Thrombosis Canada.

• #22 Diagnosis and Management of Acute Deep Vein Thrombosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/03/02/15/24/diagnosis-and-management-of-acute-deep-vein-thrombosis

  In general, patients with proximal DVT should be anticoagulated for at least 3 months. Patients with isolated distal DVT at high-risk of recurrence should be anticoagulated, as for proximal DVT; for those at low risk of recurrence, shorter treatment (4-6 weeks), even at lower anticoagulant doses, or US surveillance may be considered. […] […] In the absence of contraindications, direct oral anticoagulants should be preferred as first-line anticoagulant therapy in noncancer patients with proximal DVT. Low molecular weight heparin (LMWH) is recommended for initial and long-term treatment in cancer patients. […] […] Adjuvant catheter-directed thrombolysis may be considered in selected patients with iliocommon femoral DVT, symptoms 1 year if performed in experienced centers. Primary acute DVT stenting or mechanical thrombus removal alone are not recommended. Vena cava filters may be considered if anticoagulation is contraindicated; their use in addition to anticoagulation is not recommended. […]

• #23 Diagnosis and Management of Acute Deep Vein Thrombosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/03/02/15/24/diagnosis-and-management-of-acute-deep-vein-thrombosis

  Compression therapy associated with early mobilization and walking exercise should be considered to relieve acute venous symptoms. […] […] Decision to discontinue or not anticoagulate should be individually tailored, balancing risk of recurrence against bleeding risk, taking into account patients preferences and compliance. […] […] During pregnancy, venous US is recommended as first-line DVT imaging test. LMWH is recommended for initial and long-term treatment during pregnancy. Anticoagulant treatment should be continued for at least 6 weeks after delivery with a total of 3 months of treatment.

• #24 Diagnosis and Management of Acute Deep Vein Thrombosis

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/09/28/14/14/diagnosis-and-management-of-acute-deep-vein-thrombosis

  Various risk prediction models can be used to assess the risk of VTE recurrence. These include the Vienna model, the DASH score, and HERDOO-2. […] For extended secondary prophylaxis against recurrent DVT, patients can be treated with low-dose aspirin, apixaban 2.5 mg twice a day, or rivaroxaban 10 mg daily. In general, anticoagulation is preferred over aspirin therapy. […] For upper extremity DVT, ultrasound is the diagnostic modality of choice and treatment is similar to lower extremity DVT. […] During pregnancy, LMWH is the recommended anticoagulation for initial and long-term treatment. Anticoagulation should be continued for at least 6 weeks after delivery (for a minimum of 3 months of treatment).

• #25 Deep Venous Thrombosis (DVT) Clinical Presentation: History, Physical Examination, Pulmonary Embolism

  https://emedicine.medscape.com/article/1911303-clinical

  DVT simply cannot be diagnosed or excluded based on clinical findings; thus, diagnostic tests must be performed whenever the diagnosis of DVT is being considered. […] No single physical finding or combination of signs and symptoms is sufficiently accurate to establish the diagnosis of deep venous thrombosis (DVT). […] The classic finding of calf pain on dorsiflexion of the foot with the knee straight (Homans sign) has been a time-honored sign of DVT. […] However, Homans sign is neither sensitive nor specific: it is present in less than one third of patients with confirmed DVT, and is found in more than 50% of patients without DVT. […] Patients with venous thrombosis may have variable discoloration of the lower extremity. […] The most common abnormal hue is reddish purple from venous engorgement and obstruction.

• #26 Deep vein thrombosis (DVT) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

  Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs. […] Deep vein thrombosis can be serious because blood clots in the veins can break loose. The clots can then travel through the bloodstream and get stuck in the lungs, blocking blood flow (pulmonary embolism). […] If you develop symptoms of DVT, contact your health care provider. […] If you develop symptoms of a pulmonary embolism (PE) a life-threatening complication of deep vein thrombosis seek emergency medical help. […] A pulmonary embolism (PE) occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often start in the legs and travel up through the right side of the heart and into the lungs. This is called deep vein thrombosis (DVT).

• #27 Testing and Diagnosis for Venous Thromboembolism | Venous Thromboembolism (Blood Clots) | CDC

  https://www.cdc.gov/blood-clots/testing-diagnosis/index.html

  Computed tomographic pulmonary angiography (CTPA) is a special type of X-ray test that includes injection of contrast material (dye) into a vein. This test can provide images of the blood vessels in the lungs. It is the standard imaging test to diagnose PE. […] Pulmonary angiography is a special type of X-ray test that requires insertion of a large catheter (a long, thin hollow tube) into a large vein (usually in the groin) and into the arteries within the lung, followed by injection of contrast material (dye) through the catheter. It provides images of the blood vessels in the lung and it is the most accurate test to diagnose PE.

• #28 DVT Tests and Diagnosis

  https://www.webmd.com/dvt/dvt-tests-diagnosis

  Your doctor may give you the D-dimer blood test to figure out how likely it is that you have a pulmonary embolism. […] If the doctor says your result isnt normal, theyll recommend one or more of these other tests. […] Computed tomography (CT) pulmonary angiogram. This is the most common imaging test for diagnosing PE. It uses a special X-ray to scan your lungs for a blockage from a blood clot. It can also spot DVT in your legs. […] If your doctor diagnoses you with DVT, treatments like medication and compression stockings may be enough to prevent the clot from getting bigger or a new one from forming, while your body takes care of the clot. […] Your doctor might refer you to a blood specialist called a hematologist if you keep getting DVT or if you have a blood clotting disorder. […] Your doctor may suggest that you see a vascular specialist, an expert at diagnosing and treating problems with your blood vessels and circulation. […] They might also refer you to a vascular surgeon. They’re trained to remove any clots clogging up the flow of blood in your veins.

• #29 Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1911303-overview

  Early recognition and appropriate treatment of DVT and its complications can save many lives. […] The goals of pharmacotherapy for DVT are to reduce morbidity, prevent postthrombotic syndrome, and prevent PE. […] The presence of risk factors plays a prominent role in assessing the pretest probability of DVT. […] The most common risk factors are obesity, previous VTE, malignancy, surgery, and immobility. […] The single most powerful risk marker remains a prior history of DVT, with as many as 25% of acute venous thrombosis occurring in such patients. […] Most cases of deep venous thrombosis (DVT) are occult and usually resolve spontaneously without complication. The principal long-term morbidity from DVT is postthrombotic syndrome, which complicates about a quarter of cases of symptomatic proximal DVT; most cases develop within 2 years afterward.

• #30 Deep Vein Thrombosis – Diagnosis and Treatment – VIR Chicago

  https://www.virchicago.com/blog/deep-vein-thrombosis-diagnosis-and-treatment/

  For these patients, Interventional Radiologists can use a tiny catheter to inject clot-busting drugs to rapidly dissolve the clots from the leg or can use small devices to suck out or remove the clots. […] In some cases, DVT in the legs can cause long-lasting damage to the veins, resulting in scarring or malfunctioning of one-way valves in the veins. […] In some situations, Interventional Radiologists can perform minimally invasive procedures to open up scarred veins and promote better blood flow.

• #31 The clinical application of venous ultrasound in diagnosis and follow-up of lower extremity deep vein thrombosis (DVT): a case-based discussion | Thrombosis Journal | Full Text

  https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-023-00550-y

  We suggest clinicians to discuss with radiology colleagues if US reports thrombosis without specifying chronicity of the thrombus as acute, indeterminate or post-thrombotic change. […] The term sub-acute thrombus may be used only as a follow-up when a recent baseline US is available for comparison, otherwise thrombus may be regarded as indeterminate. […] The Society of Radiologists in Ultrasound (SRU) in their consensus report 2018 discourage the use of terms such a sub-acute thrombus. […] Guidelines have described purpose of US at end of anticoagulation therapy to establish a new baseline for future comparison: This will help in differentiating which veins have recanalized and which ones are scarred. […] We agree with Meissners review that patients who may benefit most from end of therapy US are those who are at high risk of future DVT recurrence, as it may be difficult to differentiate acute recurrent thrombus from prior scarring. […] Duration of anticoagulation decision making based on presence or absence of RVO remains an unresolved matter due to lack of consensus among various guidelines.

• #32 Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning | npj Digital Medicine

  https://www.nature.com/articles/s41746-021-00503-7

  Deep vein thrombosis (DVT) is a blood clot most commonly found in the leg, which can lead to fatal pulmonary embolism (PE). Compression ultrasound of the legs is the diagnostic gold standard, leading to a definitive diagnosis. […] Thus, diagnosis at the point of care by non-specialists is desired. […] Our method provides guidance for free-hand ultrasound and aids non-specialists in detecting DVT. […] Algorithmic DVT diagnosis performance results in a sensitivity within a 95% CI range of (0.82, 0.94), specificity of (0.70, 0.82), a positive predictive value of (0.65, 0.89), and a negative predictive value of (0.99, 1.00) when compared to the clinical gold standard. […] Clinical evidence that DVT examinations using ultrasound can be performed by nurses has been shown. […] Our hypothesis is that ML technology can complement the clinical pathway and provide non-specialists with the necessary confidence and skills to perform ultrasound DVT screening autonomously.

• #33 Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning | npj Digital Medicine

  https://www.nature.com/articles/s41746-021-00503-7

  This study provides a proof of concept that ML-based analysis can distinguish patients with and without DVT while providing image acquisition guidance for non-experts according to the clinical standard. […] Our method suggests a diagnosis based on robust segmentation in contrast to a direct image discriminator model. […] Our model learns predominantly from healthy volunteer data how a healthy vessel looks like and uses this knowledge to identify DVT suspected patients in the test data. […] To the best of our knowledge, our work is a pioneering study that shows the potential benefits of ML for the diagnosis of DVT through imaging. […] A DVT examination software tool could cost up to 72175 at the sensitivity and specificity levels measured in Table 5, before the NMB falls below 0. […] The study we describe confirms that the AutoDVT software can diagnose DVT accurately.

• #34 Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-024-00378-1

  The current meta-analysis has shown that the 2-point, 3-point, complete compression ultrasound, and whole-leg duplex POCUS protocols are excellent in diagnosing DVT in the emergency department. Combining the high diagnostic performance with the fact that POCUS significantly reduces the time from triage to DVT diagnosis, we can recommend that POCUS be utilized as the first-line imaging tool for diagnosing DVT in the emergency department.

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