Welcome to Health Care POV | sign in | join
David Plaut: Off the Cuff

A Diagnostic Algorithm for Suspected Upper-Extremity Deep Venous Thrombosis

Published May 20, 2014 2:02 PM by David Plaut

The prevalence of upper-extremity deep venous thrombosis (DVT) has risen in conjunction with more frequent use of central venous catheters. There are clear algorithms for diagnosing lower-extremity (e.g. Wells), but not for upper-extremity, DVT. A multicenter study, a diagnostic algorithm was evaluated in 406 patients with suspected upper-extremity DVTs. The study included calculating a clinical decision score consisted of +1 point each for the presence of a central venous catheter or lead, localized pain, or unilateral edema and −1 point for a plausible alternate diagnosis. Scores of ≤1 implied that upper-extremity DVT was unlikely. The algorithm in addition to the score included D-dimer testing, and ultrasonography. The patients were follow-up after 3 months.

Fifty percent of patients (203) were assigned clinical decision scores of 0 or 1 (upper-extremity DVT unlikely); 90 had normal D-dimer tests and did not undergo further testing or treatment -- none developed symptomatic DVTs. The 113 low-scoring patients with abnormal D-dimer tests underwent ultrasonography: Ultrasonography was negative in 73 -- they did not receive treatment, and none developed symptomatic DVTs. Upper-extremity DVTs were diagnosed in 12 low-scoring patients. In the 203 patients with higher scores, ultrasonography detected no upper-extremity DVTs in 83; those patients underwent D-dimer testing and repeated ultrasonography if D-dimer test were abnormal, with a yield of 3 additional DVT diagnoses. Rates of upper-extremity DVT were significantly lower in patients with scores ≤1 than in those with scores >1 (6% vs. 44%).

This study verifies the value of using d-dimer measurements to rule out DVT.

Jamaluddin Moloo, reviewing Kleinjan A et al. Ann Intern Med 2014 Apr 1.

 

posted by David Plaut

0 comments

leave a comment



To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Captcha
Enter the security code below:
 

Search

About this Blog

Keep Me Updated

Recent Posts