Materiały źródłowe

• #1 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. […] You can get deep vein thrombosis (DVT) if you have certain medical conditions that affect how the blood clots. […] Deep vein thrombosis can be serious because blood clots in the veins can break loose. […] If you develop symptoms of DVT, contact your health care provider. […] The main causes of deep vein thrombosis (DVT) are damage to a vein from surgery or inflammation and damage due to infection or injury. […] Many things can increase the risk of developing deep vein thrombosis (DVT). […] A personal or family history of DVT or pulmonary embolism (PE). […] Sometimes, a blood clot in a vein can occur with no identifiable risk factor. […] Complications of DVT can include: […] PE is a potentially life-threatening complication associated with DVT. […] Get immediate medical help if you have symptoms of PE.

• #2 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 pulmonary embolism (PE) happens when the traveling blood clots (emboli) become lodged in the blood vessels of your lung. Since this can be a life-threatening condition, you need a quick diagnosis and treatment. […] While 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. This test uses ultrasound waves to show blood flow and blood clots in your veins.

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

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

  Deep venous thrombosis classically produces pain and limb edema; however, in any given patient, symptoms may be present or absent, unilateral or bilateral, or mild or severe. Thrombus that does not cause a net venous outflow obstruction is often asymptomatic. Edema is the most specific symptom of DVT. Thrombus that involves the iliac bifurcation, the pelvic veins, or the vena cava produces leg edema that is usually bilateral rather than unilateral. High partial obstruction often produces mild bilateral edema that is mistaken for the dependent edema of right-sided heart failure, fluid overload, or hepatic or renal insufficiency. Massive edema with cyanosis and ischemia (phlegmasia cerulea dolens) is rare. […] Clinical signs and symptoms of pulmonary embolism as the primary manifestation occur in 10% of patients with confirmed DVT.

• #4 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. […] If it is suspected that a patient has a pulmonary embolism (PE) or has documented PE, the absence of tenderness, erythema, edema, or a palpable cord upon examination of the lower extremities does not rule out thrombophlebitis, nor does it imply a source other than a leg vein.

• #5 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. […] Pain or swelling of a lower limb is a common presenting complaint, and a wide differential diagnosis exists. 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 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. […] A clinical model has been devised, and prospectively validated in a large series, whereby patients are classified as having a high, intermediate, or low probability of developing deep vein thrombosis, based on history and clinical signs. This clinical model has been used in diagnostic algorithms to reduce the number of diagnostic tests required on patients with suspected deep vein thrombosis.

• #6 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.

• #7 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. […] 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.

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

  https://bestpractice.bmj.com/topics/en-gb/70

  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). […] Diagnostic investigations include quantitative D-dimer level, venous ultrasound, full blood count, urea and creatinine, liver function tests, and clotting screen. […] Investigations to consider include CT/MRI venography and further investigation for unprovoked DVT.

• #9 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. […] If it is suspected that a patient has a pulmonary embolism (PE) or has documented PE, the absence of tenderness, erythema, edema, or a palpable cord upon examination of the lower extremities does not rule out thrombophlebitis, nor does it imply a source other than a leg vein.

• #10 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.

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

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

  Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. […] Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT. […] The clinical presentation of DVT varies with the extent and location of a thrombus. […] A number of scoring systems have been devised to estimate the pre-test probability of DVT. […] In the United States, the most widely used scoring system is the Wells criteria. […] While the sensitivity of the Wells criteria can be quite high, it is clear from this data that the scoring system cannot be used as the sole diagnostic modality for DVT. […] Like the Wells scoring criteria, the D-dimer assay has a high sensitivity and relatively lower specificity for the diagnosis of DVT.

• #12 Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics

  Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) […] DEEP VEIN THROMBOSIS DIAGNOSIS […] If your history, symptoms, and physical examination suggest a DVT, you will need tests to confirm the diagnosis. Tests may include a blood test called D-dimer and compression ultrasonography of the leg veins and/or other imaging tests. […] Diagnostic tests […] D-dimer — D-dimer is a substance in the blood that is often increased in people with DVT or PE, as well as other conditions associated with infection or inflammation. D-dimer testing is sometimes useful for patients with a suspected DVT or PE. If the D-dimer test is negative and you have a low risk of DVT or PE based on your history and physical examination, DVT or PE are unlikely and further diagnostic testing may not be needed.

• #13 Deep Venous Thrombosis (DVT) Workup: Approach Considerations, D-Dimer Testing, Coagulation Profile

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

  The validation of the simpler and cheaper D-dimer test as an initial screening test permits a rapid, widely applicable screening that may reduce the rate of missed diagnoses. […] Current evidence strongly supports the use of a D-dimer assay in the setting of suspected DVT. Most studies have confirmed the clinical utility of D-dimer testing, and most clinical algorithms incorporate its use. The D-dimer assay has a high sensitivity (up to 97%); however, it has a relatively poor specificity (as low as 35%) and therefore should only be used to rule out DVT, not to confirm the diagnosis of DVT. […] A negative D-dimer assay result rules out DVT in patients with low-to-moderate risk (Wells DVT score 2). […] A negative result also obviates surveillance and serial testing in patients with moderate-to-high risk and negative ultrasonographic findings.

• #14 DVT Tests and Diagnosis

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

  If you think you may have deep vein thrombosis (DVT), the best thing you can do is call your doctor as soon as possible. There are several ways that they can figure out if you have this potentially dangerous type of blood clot. […] At your appointment, you and your doctor will discuss your symptoms and your medical history. You’ll also get a physical exam. Your doctor will use all of that to determine if you might be at risk for DVT. If they think you might have it, your doctor can confirm it with one or more of these tests. […] D-dimer test. This blood test checks for a protein called D-dimer. It’s what a blood clot makes as it dissolves inside your body. […] If the results show low or normal levels of this protein and your doctor believes you’re at low risk for a clot, you probably dont have DVT. But if you have high levels of D-dimer, you might have a blood clot. Your doctor can find out with other tests, while also ruling out other conditions that can bring on high D-dimer, like pregnancy and heart disease.

• #15 Deep Venous Thrombosis (DVT) – Core EM

  https://coreem.net/core/deep-venous-thrombosis-dvt/

• #16 Deep Venous Thrombosis (DVT) Workup: Approach Considerations, D-Dimer Testing, Coagulation Profile

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

  In appropriately selected patients with a low pretest probability of DVT or pulmonary embolism, it is reasonable to obtain a high-sensitivity D-dimer level. A negative result indicates a low likelihood of VTE. […] In patients with an intermediate to high pretest probability of lower-extremity DVT, ultrasonography is recommended. […] Diagnostic imaging studies are required in patients with an intermediate or high pretest probability of pulmonary embolism. Options include a ventilation-perfusion (V/Q) scan, multidetector helical computed tomography (CT) scan, and CT pulmonary angiography; however, CT scanning alone may not be sufficiently sensitive to exclude pulmonary embolism in patients who have a high pretest probability of pulmonary embolism. […] VTE remains an underdiagnosed disease, and most cases of pulmonary embolism are diagnosed at autopsy. The diagnosis depends on a high level of clinical suspicion and the presence of risk factors that prompt diagnostic study. Because the presentation is nonspecific and because the consequence of missing the diagnosis leads to high morbidity and mortality, VTE must be excluded whenever it is a feasible differential diagnosis.

• #17 Deep Venous Thrombosis (DVT) – Core EM

  https://coreem.net/core/deep-venous-thrombosis-dvt/

• #18 Deep vein thrombosis (DVT) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/diagnosis-treatment/drc-20352563

  To diagnose deep vein thrombosis (DVT), your health care provider will do a physical exam and ask questions about your symptoms. The provider will check the legs for swelling, tenderness or changes in skin color. […] The tests you have depend on whether your provider thinks you are at a low or a high risk of DVT. […] Tests used to diagnose or rule out DVT include: […] D-dimer blood test. D dimer is a type of protein produced by blood clots. Almost all people with severe DVT have increased blood levels of D dimer. This test often can help rule out pulmonary embolism (PE). […] Duplex ultrasound. This noninvasive test uses sound waves to create pictures of how blood flows through the veins. It’s the standard test for diagnosing DVT. […] Venography. This test uses X-rays and dye to create a picture of the veins in the legs and feet. […] Magnetic resonance imaging (MRI) scan. This test may be done to diagnose DVT in veins of the belly (abdomen).

• #19 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.

• #20 Diagnosis of deep vein thrombosis – Australian Prescriber

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

  The clinical diagnosis of deep vein thrombosis (DVT) is notoriously unreliable. Confirmation is necessary before subjecting patients to the risk of long-term anticoagulation. Ascending venography was the reference standard for the diagnosis of DVT, but it is invasive and associated with adverse effects. Consequently, venous duplex ultrasonography has become the routine initial evaluation of DVT. […] Ultrasonography is now the first test for DVT. It can be used to diagnose proximal DVT or screen high-risk patients after surgery. Serial scans can be used to follow up patients on treatment, untreated patients with calf vein thrombosis and those with a high clinical probability of DVT but an initial normal result. […] Objective testing is mandatory to confirm the diagnosis of DVT before subjecting the patients to anticoagulation.

• #21 Advanced imaging in acute and chronic deep vein thrombosis – Karande – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/13086/html

  The primary diagnostic US criteria for acute DVT remains non-compressibility of the vein with secondary diagnostic criteria being echogenic thrombus within the vein lumen, venous distention, complete absence of spectral or color Doppler signal within the vein lumen, loss of flow phasicity, and loss of response to valsalva or augmentation. […] According to American College of Radiology (ACR) guidelines and technical standards, lower extremity US should include compression, color and spectral Doppler sonography with assessment of phasicity and venous flow augmentation. […] One of the latest meta-analysis showed CTV has sensitivity ranging from 71% to 100% and specificity ranging from 93-100% for diagnosis of proximal DVT. […] ACR Appropriateness Criteria has recommended MRV to be the imaging investigation of choice for evaluation of pelvic or thigh DVT if US is non-diagnostic and as an initial imaging investigation of choice for suspected central vein thrombosis in the thorax.

• #22 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.

• #23 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.

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

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

  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. […] The gold standard for establishing the diagnosis of deep vein thrombosis has been contrast venography. However, this procedure is invasive, not always technically possible, and it carries a small risk of an allergic reaction or venous thrombosis. […] 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. However, ultrasonography cannot be relied on to diagnose calf vein thrombosis, and the sensitivity for symptomatic calf vein thrombosis has been reported to be as low as 75%.

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

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

  Diagnostic imaging is often employed to confirm the presence of DVT. […] US is the first-line imaging modality for diagnosis of proximal DVT because it is safe, easily accessible, cost-effective, and reliable. […] The primary limitation of US is its diminished ability to detect distal DVT. […] 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. […] In cases of extensive thrombus burden involving proximal deep veins, mechanical- and catheter-directed thrombolysis (CDT) may be indicated in the acute phase to rapidly induce clot lysis and reduce the risk of post-thrombotic syndrome. […] However, thrombolytic therapy is associated with an increased risk of major bleeding and has shown no mortality benefit in patients with DVT.

• #26 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: 87.5897.06), 96.86% (95% CI: 95.0998.64), 88.41% (95% CI: 82.2494.58) and 97.25% (95% CI: 95.5198.99), respectively. Similarly, the pooled sensitivity, specificity, PPV, and NPV for 3-point POCUS were 89.15% (95% CI: 83.2495.07), 92.71% (95% CI: 89.5995.83), 81.27% (95% CI: 73.7988.75), and 95.47% (95% CI: 92.9398).

• #27 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 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.

• #28 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.

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

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

  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. […] The gold standard for establishing the diagnosis of deep vein thrombosis has been contrast venography. However, this procedure is invasive, not always technically possible, and it carries a small risk of an allergic reaction or venous thrombosis. […] 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. However, ultrasonography cannot be relied on to diagnose calf vein thrombosis, and the sensitivity for symptomatic calf vein thrombosis has been reported to be as low as 75%.

• #30 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Deep-Vein-Thrombosis-(DVT)-Symptoms-and-Diagnosis.aspx

  Not all DVTs cause noticeable symptoms, but the most common are swelling and redness in the affected leg, often associated with some pain in the same area. […] Although a number of tests have been evaluated over the years, only three have been shown to have special value for diagnosing DVT in symptomatic patients: venous ultrasonography, venography and impedance plethysmography (IPG). […] Venous Ultrasonography of the venous system is obtained with high-resolution equipment to produce two-dimensional images of reflected signals from an array of ultrasound sources, including the common femoral vein in the groin and the popliteal vein, which connects to the femoral vein. […] Venography is performed by injecting radiographic material into a superficial vein on the top of the foot. […] Impedance plethysmography (IPG) is performed by placing two sets of electrodes around the patient’s calf and an oversized blood pressure cuff around the thigh.

• #31 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.

• #32 Deep Vein Thrombosis (DVT) – Maryland Oncology Hematology

  https://marylandoncology.com/blood-disorders/deep-vein-thrombosis-dvt/

  To diagnose DVT, your doctor will ask you about your symptoms and will perform a physical exam to check for areas of swelling, tenderness, or changes in skin color. They will recommend specific tests based on whether you are at low or high risk for blood clots. […] […] Tests used to diagnose or rule out a blood clot include: D-dimer blood test. D-dimer is a protein fragment (small piece) made when a blood clot dissolves in your body. Almost all people with severe deep vein thrombosis have increased blood levels of D-dimer. Duplex ultrasound. This is the most common test used to diagnose DVT. It involves using high-frequency sound waves to look at the speed of blood flow to see if clots are present. Sometimes, the ultrasound technician will need to do a series of scans over several days to determine whether a blood clot is growing or to check for a new one. Magnetic resonance imaging (MRI) scan. This test may be done to diagnose DVT in the veins of the abdomen. Venography. This test uses X-rays to show your deep veins. A dye is injected into a large vein in your foot or ankle so veins and any blood clots can be seen more clearly. The test is invasive, so it is rarely performed. […]

• #33 Advanced imaging in acute and chronic deep vein thrombosis – Karande – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/13086/html

  The imaging of DVT has evolved over the past few decades from conventional contrast venography and duplex sonography to computed tomography (CT)/magnetic resonance venography (MR venography) and scintigraphy and the latest molecular imaging/nanotechnology. […] Historically, contrast venography was the first imaging procedure available for diagnosing DVT and is still considered the gold standard with clot being identified as a filling defect or non-opacification of the vein. However, it is an invasive procedure that requires expertise and large volume of intravenous contrast. […] US is used in evaluation of both symptomatic and asymptomatic DVT (patients at high risk of DVT). It is useful not only in assessing DVT but can also identify other conditions causing signs and symptoms indistinguishable from DVT.

• #34 Blood Clots – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/bloodclot

  Your doctor will likely perform a physical examination, and you may undergo a venous ultrasound or a CT angiography (CTA) scan of the chest, abdomen/pelvis or head to help diagnose your condition. […] Evaluation of your condition differs depending on the location and type of your blood clot. Your doctor will usually begin by obtaining your medical history, as this may provide information about factors that caused the clot, and will also perform a physical examination. […] You may be sent for one or more of the following tests: Venous ultrasound: This test is usually the first step for confirming a venous blood clot. […] If you are diagnosed with a deep venous clot, you will be put on blood thinning medication to help thin your blood and allow it to pass more easily past the site of the clot. […] Your doctor may ask you to undergo a procedure called inferior vena cava filter placement. This is recommended for patients who are at high risk for blood clots.

• #35 Advanced imaging in acute and chronic deep vein thrombosis – Karande – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/13086/html

  The primary diagnostic US criteria for acute DVT remains non-compressibility of the vein with secondary diagnostic criteria being echogenic thrombus within the vein lumen, venous distention, complete absence of spectral or color Doppler signal within the vein lumen, loss of flow phasicity, and loss of response to valsalva or augmentation. […] According to American College of Radiology (ACR) guidelines and technical standards, lower extremity US should include compression, color and spectral Doppler sonography with assessment of phasicity and venous flow augmentation. […] One of the latest meta-analysis showed CTV has sensitivity ranging from 71% to 100% and specificity ranging from 93-100% for diagnosis of proximal DVT. […] ACR Appropriateness Criteria has recommended MRV to be the imaging investigation of choice for evaluation of pelvic or thigh DVT if US is non-diagnostic and as an initial imaging investigation of choice for suspected central vein thrombosis in the thorax.

• #36 Diagnosing Deep Vein Thrombosis | NYU Langone Health

  https://nyulangone.org/conditions/deep-vein-thrombosis/diagnosis

  Doctors may use this test in people who should not have a CT scan, such as those who have renal insufficiencypoorly functioning kidneysor an allergy to iodine, a substance used in CT contrast dyes. […] This test is used if the doctor also plans to treat blood clots directly with thrombolytic, or clot-busting, medication or removal of the clot by thrombectomy.

• #37 Deep vein thrombosis (DVT) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/diagnosis-treatment/drc-20352563

  To diagnose deep vein thrombosis (DVT), your health care provider will do a physical exam and ask questions about your symptoms. The provider will check the legs for swelling, tenderness or changes in skin color. […] The tests you have depend on whether your provider thinks you are at a low or a high risk of DVT. […] Tests used to diagnose or rule out DVT include: […] D-dimer blood test. D dimer is a type of protein produced by blood clots. Almost all people with severe DVT have increased blood levels of D dimer. This test often can help rule out pulmonary embolism (PE). […] Duplex ultrasound. This noninvasive test uses sound waves to create pictures of how blood flows through the veins. It’s the standard test for diagnosing DVT. […] Venography. This test uses X-rays and dye to create a picture of the veins in the legs and feet. […] Magnetic resonance imaging (MRI) scan. This test may be done to diagnose DVT in veins of the belly (abdomen).

• #38 Venous Thromboembolism – Deep Vein Thrombosis (DVT) | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/deep-vein-thrombosis

  Call your healthcare provider right away if you think you may have symptoms of deep vein thrombosis, or DVT. DVT should be taken seriously, as it may lead to a life-threatening pulmonary embolism (PE). […] Your provider will diagnose DVT based on your symptoms, medical history, a physical exam, and various imaging or blood test results. […] D-dimer tests measure a substance in the blood that is released when the fibrin protein (proteins that help stop bleeding) in a blood clot dissolve. If the test shows high levels of the substance, you may have DVT. These tests may be used as a first step to look for signs of a blood clot in otherwise healthy people. […] Compression ultrasound looks for blood clots in the deep veins of your legs. This test uses sound waves to create pictures of blood flowing in your veins. The person doing the test may press on your veins to see whether the veins compress normally or are stiff with blood clots. […] Magnetic resonance venography uses a specialized magnet to take images of your veins. Your provider will need to give you a special dye through an intravenous tube (IV) before the test. This test is usually only used if your provider cannot diagnose DVT from the compression ultrasonography results.

• #39 Diagnosing Deep Vein Thrombosis | NYU Langone Health

  https://nyulangone.org/conditions/deep-vein-thrombosis/diagnosis

  Doctors may use this test in people who should not have a CT scan, such as those who have renal insufficiencypoorly functioning kidneysor an allergy to iodine, a substance used in CT contrast dyes. […] This test is used if the doctor also plans to treat blood clots directly with thrombolytic, or clot-busting, medication or removal of the clot by thrombectomy.

• #40 Advanced imaging in acute and chronic deep vein thrombosis – Karande – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/13086/html

  The ideal MRV technique for DVT would be rapid, highly accurate without need of intravenous contrast administration. […] The advantages and disadvantages of the various modalities used for imaging DVT have been summarized. […] The incidence of DVT is increasing, not just in the lower extremity but also in upper extremity, where malignancy and central venous catheters are the major precipitating factors. While US still has advantages, it has various limitations and in such cases advanced imaging techniques such as MRI, should be considered.

• #41 Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics

  Compression ultrasonography — Compression ultrasonography uses sound waves to generate pictures of the structures inside the leg. For this type of examination, you lie on your back and then stomach as an ultrasound wand is applied to the leg. In most circumstances, compression ultrasonography is the test of choice for patients with suspected DVT. […] Other imaging tests — Although no longer used widely for diagnosis, in some cases (eg, if it is not possible to perform ultrasonography for some reason) another imaging test may done. These include magnetic resonance imaging (MRI; which uses a strong magnet to produce detailed pictures of the inside of the body) and computed tomography (CT) scan. […] Finding the cause of a blood clot — After confirming that DVT or PE is present, the health care provider will want to know what caused it. In many cases, there are obvious risk factors such as recent surgery or immobility. In other cases, the clinician may test for the presence of a thrombophilia or for another medical condition associated with an increased risk for venous thrombosis (such as cancer).

• #42 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. […] 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.

• #43 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

  Diagnosis and Management of Acute Deep Vein Thrombosis […] The following are key points to remember from this European Society of Cardiology consensus document about diagnosis and management of acute deep vein thrombosis (DVT): Clinical signs and symptoms of acute DVT are highly variable and nonspecific. Use of the Wells score to assess pretest probability is recommended. […] For patients with DVT unlikely pretest probability, a D-dimer test should be ordered. If negative, then acute DVT is ruled out and no treatment is necessary. […] For patients with DVT likely on pretest probability or a positive D-dimer, then a complete venous ultrasound should be performed. […] Patients with isolated distal DVT and a high risk of recurrence should be treated with 3 months of anticoagulation. If the risk of recurrence is low, then they can be treated with a short course (4-6 weeks) of anticoagulation (prophylactic dose or full dose) or with surveillance compression ultrasound. […] Patients with proximal DVT should receive at least 3 months of anticoagulation therapy. An extended course of anticoagulation should be determined based on a combination of venous ultrasound findings, risk/benefit balance, patient compliance with therapy, and the patients preference. […] Patients without cancer should be treated with direct oral anticoagulants (DOACs) or warfarin, while patients with cancer should receive low molecular weight heparin (LMWH). […] For acute DVT, initial anticoagulation should be one of the following regimens: 1) apixaban 10 mg twice a day for 7 days, then 5 mg twice a day; 2) dabigatran 150 mg twice a day after a 5- to 10-day lead-in course of LMWH; 3) edoxaban 60 mg daily (30 mg if creatinine clearance 30-50 ml/min or potent proton pump inhibitor use) after a 5- to 10-day lead-in course; 4) rivaroxaban 15 mg twice a day for 21 days, then 20 mg daily; or 5) warfarin with a goal international normalized ratio (INR) 2-3 and LMWH for 5-10 days (until INR 2). […] 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).

• #44 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.

• #45 Deep Vein Thrombosis (DVT) | Doctor

  https://patient.info/doctor/deep-vein-thrombosis-pro

  A DVT can be very difficult to diagnose but early recognition and appropriate treatment can save many lives. […] If a patient presents with signs or symptoms of DVT, carry out an assessment of general medical history and a physical examination to exclude other causes. […] Offer patients in whom DVT is suspected and with a likely two-level DVT Wells’ score either: A proximal leg vein ultrasound scan carried out within four hours of being requested and, if the result is negative, a D-dimer test; or A D-dimer test and an interim 24-hour dose of a parenteral anticoagulant. […] Diagnose DVT and treat patients with a positive proximal leg vein ultrasound scan. […] Duplex ultrasound is the initial investigation of choice in nearly all patients with suspected DVT. […] It has a sensitivity of 98.7% and specificity of 100% for above-knee DVT and a sensitivity of 85.2% and specificity of 98.2% for below-knee DVT, when compared with the gold standard (invasive venography).

• #46 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. [...] D-Dimer is a marker of fibrin clot breakdown. [...] It is a highly sensitive (up to 90%) but non-specific test. [...] 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.

• #47 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.

• #48 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. […] 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.

• #49 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.

• #50 Deep Vein Thrombosis (DVT) | Doctor

  https://patient.info/doctor/deep-vein-thrombosis-pro

  The risk of DVT is likely if the score is two or more, and unlikely if the score is one or less. […] These are specific cross-linked products of fibrin degradation and are raised in patients with VTE. […] Imaging is normally carried out by two-dimensional ultrasound but can be by venography, computerised tomography (CT) venography or by magnetic resonance imaging. […] An anticoagulant should be chosen that can be continued if DVT is confirmed. […] People with confirmed proximal DVT should be offered apixaban or rivaroxaban first-line, and if these are not suitable be offered LMWH for at least five days followed by dabigatran or edoxaban. […] Consider extending the anticoagulant beyond three months for patients with unprovoked proximal DVT if their risk of VTE recurrence is high and there is no additional risk of major bleeding.

• #51 Standalone D-dimer Test Strategy May Simplify Diagnosis of Deep Vein Thrombosis – Hematology.org

  https://www.hematology.org/newsroom/press-releases/2020/standalone-d-dimer-test-strategy-may-simplify-diagnosis-of-deep-vein-thrombosis

  New research suggests that it may be possible to simplify the diagnosis of deep vein thrombosis (DVT) without compromising accuracy. […] Using only a D-dimer blood test may help health care providers identify patients who require additional screening, according to a new study in Blood Advances. […] Current guidelines for diagnosing DVT recommend conducting pre-test probability assessments before proceeding with D-dimer blood tests and/or ultrasound examinations. […] Our study aimed to assess whether diagnosing DVT could be made easier, said study author Synne Fronas, MD, of the department of emergency medicine of stfold Hospital in Norway. […] To our knowledge, this is the first large prospective study to assess the clinical outcomes of a diagnostic strategy using standalone D-dimer, said Dr. Fronas. […] We believe using D-dimer as the first test is easier and less user-dependent than the traditional clinical prediction model. Overall, this strategy could reduce the cost, time, and resources required to diagnose DVT, said Dr. Fronas.

• #52 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. […] However, many patients with possible symptoms are not found to have a DVT, resulting in long referral waiting times for patients and a large clinical burden for specialists. 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.

• #53 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

  Rapid diagnosis is known to improve compliance to regulatory guidelines that state DVT should be diagnosed within 24h. […] 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. […] 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. […] Algorithmic DVT diagnosis results in a sensitivity within a 95% CI range of (0.82, 0.94), specificity of (0.70, 0.82), the positive predictive value (PPV) of (0.65, 0.89), and a negative predictive value (NPV) of (0.99, 1.00).

• #54 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

  Rapid diagnosis is known to improve compliance to regulatory guidelines that state DVT should be diagnosed within 24h. […] 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. […] 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. […] Algorithmic DVT diagnosis results in a sensitivity within a 95% CI range of (0.82, 0.94), specificity of (0.70, 0.82), the positive predictive value (PPV) of (0.65, 0.89), and a negative predictive value (NPV) of (0.99, 1.00).

• #55 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

  Our method suggests a diagnosis based on robust segmentation in contrast to a direct image discriminator model. […] Our work evaluates all implications for the implementation of a ML model in a challenging clinical workflow like DVT diagnosis with ultrasound imaging, a pathway that requires direct human-machine interaction. […] The ultimate goal of employing AI support for DVT diagnosis would be to develop a ML-powered system using free-hand ultrasound that enables healthcare generalists at the point of care to exclude the presence of DVT in negative cases. […] The study we describe confirms that the AutoDVT software can diagnose DVT accurately.

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

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

  In patients with an increased risk of bleeding or absolute contraindication to anticoagulation therapy, an inferior vena cava filter can be placed to prevent progression to PE. […] The effectiveness of dabigatran for treatment of DVT has been confirmed in three recent double-blind randomized controlled trials: RE-COVER, REMEDY, and RESONATE. […] Rivaroxaban, a direct factor Xa inhibitor, has been shown to be as effective as warfarin for DVT in randomized controlled trials. […] Apixaban was compared to warfarin therapy for DVT in the AMPLIFY trial. […] The HOKUSAI-VTE study compared edoxaban, an oral direct thrombin inhibitor, to warfarin for treatment of VTE. […] 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.

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

  https://bestpractice.bmj.com/topics/en-gb/70

  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). […] Diagnostic investigations include quantitative D-dimer level, venous ultrasound, full blood count, urea and creatinine, liver function tests, and clotting screen. […] Investigations to consider include CT/MRI venography and further investigation for unprovoked DVT.

• #58 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/

  D-dimer is among the most common and widely available screening tests for DVT and PE. D-dimer is a fibrin clot degradation product which is increased in patients with both acute and chronic 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. […] In outpatient settings, the preferential diagnostic imaging choice should be venous compression ultrasound. […] Anticoagulation is the mainstay for management of DVTs with the goal of preventing progression, recurrence, and providing acute relief of symptoms.

• #59 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.

• #60 Health Care Providers (HCPs) – Addressing the Patient with Suspected DVT – The Society for Vascular Medicine

  https://mydeepveinthrombosis.com/addressing-the-patient-with-suspected-dvt/

  Many patients with acute deep venous thrombosis (DVT) can be safely and effectively treated without the need for emergency department visit. […] When patients present with signs and symptoms of deep vein thrombosis (DVT), it is important to evaluate for signs that require emergent evaluation: signs of limb ischemia, or any signs concerning for a pulmonary embolism (e.g., tachycardia, tachypnea, shortness of breath or hypoxia). […] For low or moderate probability patients, using a D-dimer test can help to rule out a DVT with a high degree of certainty. […] If the DVT scan is negative, then clinical follow up is important. If, however, the DVT scan is positive, then initiating treatment acutely is important. […] Patients with mechanical valves or severe renal dysfunction should receive warfarin therapy (direct oral anticoagulant use is not advised). […] It is important to continue to follow acute DVT patients to ensure that they are able to obtain their anticoagulant and that they do not have complications or recurrent DVT.

• #61 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 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.

• #62 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 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.

• #63 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/

  Typical options for initial treatment of DVT include the DOAC medications which can, but not necessarily need to, be preceded by parenteral anticoagulation, such as a LMWH. […] 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. […] Per current recommendations, the next step would be to complete a high-sensitivity D-dimer blood test. […] In moderate-risk patients with a negative high-sensitivity D-dimer by point-of-care testing, DVT can be ruled out with a negative predictive value of 96.1% and no further testing. […] Unfortunately, most urgent care settings do not have rapid D-dimer testing available on site. Having point-of-care high-sensitivity D-dimer testing in urgent cares would be beneficial in preventing delay of care, diagnostic uncertainty, and associated costs.

• #64 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.

• #65 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.

• #66 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. […] 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. […] The MR machine uses pulses of radio-frequency waves to cause hydrogen atoms to line up within tissues. […] 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.

• #67 Deep Venous Thrombosis (DVT) Workup: Approach Considerations, D-Dimer Testing, Coagulation Profile

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

  The criterion standard to diagnostic imaging for DVT remains venography with pedal vein cannulation, intravenous contrast injection, and serial limb radiographs. […] MRI has increasingly been investigated for evaluation of suspected DVT. Limited studies suggest the accuracy of contrast venography. MRI is the diagnostic test of choice for suspected iliac vein or inferior vena caval thrombosis when computed tomography venography is contraindicated or technically inadequate. […] The Wells clinical prediction guide quantifies the pretest probability of deep venous thrombosis. The model enables physicians to reliably stratify their patients into high-risk, moderate-risk, or low-risk categories. Combining this with the results of objective testing greatly simplifies the clinical workup of patients with suspected DVT.

• #68 Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics

  Compression ultrasonography — Compression ultrasonography uses sound waves to generate pictures of the structures inside the leg. For this type of examination, you lie on your back and then stomach as an ultrasound wand is applied to the leg. In most circumstances, compression ultrasonography is the test of choice for patients with suspected DVT. […] Other imaging tests — Although no longer used widely for diagnosis, in some cases (eg, if it is not possible to perform ultrasonography for some reason) another imaging test may done. These include magnetic resonance imaging (MRI; which uses a strong magnet to produce detailed pictures of the inside of the body) and computed tomography (CT) scan. […] Finding the cause of a blood clot — After confirming that DVT or PE is present, the health care provider will want to know what caused it. In many cases, there are obvious risk factors such as recent surgery or immobility. In other cases, the clinician may test for the presence of a thrombophilia or for another medical condition associated with an increased risk for venous thrombosis (such as cancer).

• #69 Advanced imaging in acute and chronic deep vein thrombosis – Karande – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/13086/html

  The ideal MRV technique for DVT would be rapid, highly accurate without need of intravenous contrast administration. […] The advantages and disadvantages of the various modalities used for imaging DVT have been summarized. […] The incidence of DVT is increasing, not just in the lower extremity but also in upper extremity, where malignancy and central venous catheters are the major precipitating factors. While US still has advantages, it has various limitations and in such cases advanced imaging techniques such as MRI, should be considered.

• #70 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

  Diagnosis and Management of Acute Deep Vein Thrombosis […] The following are key points to remember from this European Society of Cardiology consensus document about diagnosis and management of acute deep vein thrombosis (DVT): Clinical signs and symptoms of acute DVT are highly variable and nonspecific. Use of the Wells score to assess pretest probability is recommended. […] For patients with DVT unlikely pretest probability, a D-dimer test should be ordered. If negative, then acute DVT is ruled out and no treatment is necessary. […] For patients with DVT likely on pretest probability or a positive D-dimer, then a complete venous ultrasound should be performed. […] Patients with isolated distal DVT and a high risk of recurrence should be treated with 3 months of anticoagulation. If the risk of recurrence is low, then they can be treated with a short course (4-6 weeks) of anticoagulation (prophylactic dose or full dose) or with surveillance compression ultrasound. […] Patients with proximal DVT should receive at least 3 months of anticoagulation therapy. An extended course of anticoagulation should be determined based on a combination of venous ultrasound findings, risk/benefit balance, patient compliance with therapy, and the patients preference. […] Patients without cancer should be treated with direct oral anticoagulants (DOACs) or warfarin, while patients with cancer should receive low molecular weight heparin (LMWH). […] For acute DVT, initial anticoagulation should be one of the following regimens: 1) apixaban 10 mg twice a day for 7 days, then 5 mg twice a day; 2) dabigatran 150 mg twice a day after a 5- to 10-day lead-in course of LMWH; 3) edoxaban 60 mg daily (30 mg if creatinine clearance 30-50 ml/min or potent proton pump inhibitor use) after a 5- to 10-day lead-in course; 4) rivaroxaban 15 mg twice a day for 21 days, then 20 mg daily; or 5) warfarin with a goal international normalized ratio (INR) 2-3 and LMWH for 5-10 days (until INR 2). […] 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).

• #71

  https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/deep-vein-thrombosis/diagnosing-dvt.html

  Signs of deep vein thrombosis (DVT) are only are only found in about half of patients, and it is often difficult to differentiate from non-thrombotic disorders. […] Early detection provides physicians with a wider range of treatment options for their patients, including thrombus removal, which can only occur within up to 28 days of symptoms onset. […] This diagnostic protocol for suspected DVT was developed by the NICE (National Institute for Health and Care Excellence).

• #72 Deep vein thrombosis: Definition, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/153704

  DVT needs urgent medical attention as a PE can be life-threatening. The Centers for Disease Control and Prevention (CDC) say that 1030% of people who develop DVT in the leg experience fatal complications within a month of diagnosis. […] If a person suspects that they may have DVT, they should seek immediate medical attention. The doctor will ask questions about symptoms and medical history before carrying out a physical examination. […] A doctor will usually not be able to diagnose DVT through symptoms alone and may recommend tests, including: […] D-dimer test: D-dimer is a protein fragment that is present in blood after a blood clot fibrinolysis degrades a blood clot. A test result revealing more than a certain amount of D-dimer indicates a possible blood clot. However, this test may not be reliable in individuals with certain inflammatory conditions and after surgery.

• #73

  https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/deep-vein-thrombosis/diagnosing-dvt.html

  Signs of deep vein thrombosis (DVT) are only are only found in about half of patients, and it is often difficult to differentiate from non-thrombotic disorders. […] Early detection provides physicians with a wider range of treatment options for their patients, including thrombus removal, which can only occur within up to 28 days of symptoms onset. […] This diagnostic protocol for suspected DVT was developed by the NICE (National Institute for Health and Care Excellence).

• #74 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

  Rapid diagnosis is known to improve compliance to regulatory guidelines that state DVT should be diagnosed within 24h. […] 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. […] 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. […] Algorithmic DVT diagnosis results in a sensitivity within a 95% CI range of (0.82, 0.94), specificity of (0.70, 0.82), the positive predictive value (PPV) of (0.65, 0.89), and a negative predictive value (NPV) of (0.99, 1.00).

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

  https://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. […] This is called Post Thrombotic Syndrome or PTS. In some situations, Interventional Radiologists can perform minimally invasive procedures to open up scarred veins and promote better blood flow.

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

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

  In patients with an increased risk of bleeding or absolute contraindication to anticoagulation therapy, an inferior vena cava filter can be placed to prevent progression to PE. […] The effectiveness of dabigatran for treatment of DVT has been confirmed in three recent double-blind randomized controlled trials: RE-COVER, REMEDY, and RESONATE. […] Rivaroxaban, a direct factor Xa inhibitor, has been shown to be as effective as warfarin for DVT in randomized controlled trials. […] Apixaban was compared to warfarin therapy for DVT in the AMPLIFY trial. […] The HOKUSAI-VTE study compared edoxaban, an oral direct thrombin inhibitor, to warfarin for treatment of VTE. […] 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.

• #77 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

  Our method suggests a diagnosis based on robust segmentation in contrast to a direct image discriminator model. […] Our work evaluates all implications for the implementation of a ML model in a challenging clinical workflow like DVT diagnosis with ultrasound imaging, a pathway that requires direct human-machine interaction. […] The ultimate goal of employing AI support for DVT diagnosis would be to develop a ML-powered system using free-hand ultrasound that enables healthcare generalists at the point of care to exclude the presence of DVT in negative cases. […] The study we describe confirms that the AutoDVT software can diagnose DVT accurately.

• #78 ASH VTE Guidelines: Diagnosis of Venous Thromboembolism – Hematology.org

  https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/venous-thromboembolism-guidelines/diagnosis

  Accurate diagnosis of VTE is important due to the morbidity and mortality associated with missed diagnoses and the potential side effects, patient inconvenience, and resource implications of anticoagulant treatment given for VTE. […] These guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. […] Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE.

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