Diagnosis of Recurrent Deep Vein Thrombosis

 

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ABSTRACT

Long-term follow-up studies demonstrated that venous thromboembolism is a chronic disease, as the rate of recurrent deep vein thrombosis (DVT) continuously increases after the primitive thrombotic episode.

Objective testing is mandatory to confirm or refute the presence of recurrent DVT, as only 30% of patients with suspected recurrence have a new documented thrombotic episode. There is no consensus on the preferred diagnostic procedure; furthermore, both invasive and noninvasive methods are limited in this context. Venography, the established gold standard, is invasive, costly, inconvenient and requires high technical skills. Among noninvasive techniques, serial impedance plethysmography, alone or in combination with leg scanning and venography, and serial compression ultrasound (CUS), were adequately investigated.

At present, the recommended approach is represented by a quantitative CUS method that possesses an excellent reproducibility and accuracy. The safety of withholding anticoagulants from patients with a normal quantitative CUS work-up has been recently demonstrated in a prospective management study.

REFERENCES

• 1 Prandoni P, Lensing A WA, Cogo A. The long-term clinical course of acute deep venous thrombosis.  Ann Intern Med . 1996;  125 1-7
  CrossrefPubMedGoogle Scholar
• 2 Simioni P, Prandoni P, Lensing A W. The risk of recurrent venous thromboembolism in patients with an Arg506→Gln mutation in the gene for factor V (factor V Leiden).  N Engl J Med . 1997;  336 399-403
  CrossrefPubMedGoogle Scholar
• 3 Simioni P, Prandoni P, Lensing A WA. Risk for subsequent venous thromboembolic complications in carriers of the prothrombin or the factor V gene mutation with a first episode of deep-vein thrombosis.  Blood . 2000;  96 3329-3333
  PubMedGoogle Scholar
• 4 Schulman S, Rhedin A S, Lindmarker P. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism.  N Engl J Med . 1995;  332 1661-1665
  CrossrefPubMedGoogle Scholar
• 5 Grau E, Real E, Medrano J, Pastor E, Selfa S. Recurrent venous thromboembolism in a Spanish population: incidence, risk factors, and management in a hospital setting.  Thromb Res . 1999;  96 335-341
  CrossrefPubMedGoogle Scholar
• 6 Kearon C, Gent M, Hirsh J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.  N Engl J Med . 1999;  340 901-907
  PubMedGoogle Scholar
• 7 Margaglione M, D'Andrea G, Colaizzo D. Coexistence of factor V Leiden and Factor II A20210 mutations and recurrent venous thromboembolism.  Thromb Haemost . 1999;  82 1583-1587
  PubMedGoogle Scholar
• 8 Hull R D, Raskob G E, Brant R F, Pineo G F, Valentine K A. The importance of initial heparin treatment on long-term clinical outcomes of antithrombotic therapy. The emerging theme of delayed recurrence.  Arch Intern Med . 1997;  157 2317-2321
  CrossrefPubMedGoogle Scholar
• 9 Schulman S, Granqvist S, Holmström M. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism.  N Engl J Med . 1997;  336 393-398
  CrossrefPubMedGoogle Scholar
• 10 Franzeck U K, Schalch I, Jäger K A, Schneider E, Grimm J, Bollinger A. Prospective 12-year follow-up study of clinical and haemodinamic sequelae after deep vein thrombosis in low-risk patients (Zürich study).  Circulation . 1996;  93 74-79
  PubMedGoogle Scholar
• 11 Hainaut P, Azerad M A, Lehmann F. Prevalence of activated protein C resistance and analysis of clinical profile in thromboembolic patients. A Belgian prospective study.  J Int Med . 1997;  241 427-433
  PubMedGoogle Scholar
• 12 De Stefano V, Martinelli I, Mannucci P M. The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation.  N Engl J Med . 1999;  341 801-806
  CrossrefPubMedGoogle Scholar
• 13 Hull R D, Raskob G E, Brant R F, Pineo G F, Valentine K A. Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis.  Arch Intern Med . 1997;  157 2562-2568
  CrossrefPubMedGoogle Scholar
• 14 Lensing A WA, Prins M H, Davidson B L, Hirsh J. Treatment of deep venous thrombosis with low-molecular weight heparins. A meta-analysis.  Arch Intern Med . 1995;  155 601-607
  CrossrefPubMedGoogle Scholar
• 15 Siragusa S, Cosmi B, Piovella F, Hirsh J, Ginsberg J S. Low-molecular weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: results of a meta-analysis.  Am J Med . 1996;  100 269-277
  CrossrefPubMedGoogle Scholar
• 16 Anand S S, Bates S, Ginsberg J S. Recurrent venous thrombosis and heparin therapy: an evaluation of the importance of early activated partial thromboplastin times.  Arch Intern Med . 1999;  27 2029-2032
  PubMedGoogle Scholar
• 17 Fennerty A G, Dolben J, Thomas P. A comparison of 3 and 6 weeks' anticoagulation in the treatment of venous thromboembolism.  Clin Lab Haemat . 1987;  9 17-21
  PubMedGoogle Scholar
• 18 Haeger K. Problems of acute deep-vein thrombosis: the interpretation of signs and symptoms.  Angiology . 1969;  20 219-223
  Google Scholar
• 19 Hull R D, Carter C J, Jay R M. The diagnosis of acute recurrent deep-vein thrombosis: a diagnostic challenge.  Circulation . 1983;  67 901-906
  PubMedGoogle Scholar
• 20 Huisman M V, Büller H R, ten Cate W J. Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis.  Arch Int Med . 1988;  148 681-683
  PubMedGoogle Scholar
• 21 Prandoni P, Cogo A, Bernardi E. A simple ultrasound approach for detection of recurrent proximal-vein thrombosis.  Circulation . 1993;  88 1730-1735
  CrossrefPubMedGoogle Scholar
• 22 Kraaijenhagen R A, Lensing A W, Lijmer J G. Diagnostic strategies for the management of patients with clinically suspected deep-vein thrombosis.  Curr Opin Pulm Med . 1997;  3 268-274
  PubMedGoogle Scholar
• 23 Kearon C, Julian J A, Newman T E, Ginsberg J S. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative.  Ann Intern Med . 1998;  128 663-677
  Google Scholar
• 24 Koopman M M, Buller H R, ten Cate W J. Diagnosis of recurrent deep vein thrombosis.  Haemostasis . 1995;  25 49-57
  PubMedGoogle Scholar
• 25 Belcaro G. Evaluation of recurrent deep venous thrombosis using colour duplex scanning-comparison with venography.  Vasa . 1992;  21 22-26
  PubMedGoogle Scholar
• 26 Huisman M V. Recurrent venous thromboembolism: diagnosis and management.  Curr Opin Pulm Med . 2000;  6 330-334
  CrossrefPubMedGoogle Scholar
• 27 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg.  Arch Surg . 1972;  104 134-144
  PubMedGoogle Scholar
• 28 Ruehm S G, Wiesner W, Debatin J F. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience.  Radiology . 2000;  215 421-427
  CrossrefPubMedGoogle Scholar
• 29 Baldt M M, Zontsich T, Stumpfelen A. Deep venous thrombosis of the lower extremity: efficacy of spiral CT venography compared with conventional venography in diagnosis.  Radiology . 1996;  200 423-428
  Google Scholar
• 30 Leclerc J R, Jay R M, Hull R D, Hirsh J. Recurrent leg symptoms following deep vein thrombosis.  Arch Intern Med . 1985;  145 1867-1869
  CrossrefPubMedGoogle Scholar
• 31 Huisman M V, Büller H R, ten Cate W J, Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients.  N Engl J Med . 1986;  314 823-886
  PubMedGoogle Scholar
• 32 Jay R, Hull R D, Carter C J. Outcome of abnormal impedance plethysmography results in patients with proximal-vein thrombosis: frequency of return to normal.  Thromb Res . 1984;  36 259-263
  CrossrefPubMedGoogle Scholar
• 33 Prandoni P, Lensing A W, Buller H. Failure of computerized impedance plethysmography in the diagnostic management of patients with clinically suspected deep-vein thrombosis.  Thromb Haemost . 1991;  65 233-236
  PubMedGoogle Scholar
• 34 Anderson D R, Lensing A W, Wells P S. Limitations of impedance plethysmography in the diagnosis of clinically suspected deep-vein thrombosis.  Ann Intern Med . 1993;  118 25-30
  PubMedGoogle Scholar
• 35 Heijboer H, Büller H R, Lensing A WA, Turpie A GG, Colly L P, ten Cate W J. A comparison of real-time ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients.  N Engl J Med . 1993;  329 1365-1369
  Google Scholar
• 36 Lensing A WA, Prandoni P, Brandjes D. Detection of deep-vein thrombosis by real-time B-mode ultrasonography.  N Engl J Med . 1989;  320 342-345
  Google Scholar
• 37 Heijboer H, Joenbloets L M, Buller H, Lensing A W, ten Cate W J. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis.  Acta Radiol . 1992;  33 297-300
  CrossrefPubMedGoogle Scholar
• 38 Cronan J, Leen V. Recurrent deep venous thrombosis: limitations of US.  Radiology . 1989;  170 739-742
  PubMedGoogle Scholar
• 39 Murphy T P, Cronan J. Evolution of deep venous thrombosis: a prospective evaluation with US.  Radiology . 1990;  177 543-548
  PubMedGoogle Scholar
• 40 van Ramshorst B, van Bemmelen S P, Hoeneveld H, Faber J A, Eikebloom B C. Thrombus regression in deep venous thrombosis: quantification of spontaneous thrombolysis with duplex scanning.  Circulation . 1992;  86 414-419
  CrossrefPubMedGoogle Scholar
• 41 Koopman M M, Jongbloets L, Lensing A W. Clinical utility of a quantitative B-mode ultrasonography method in patients with suspected recurrent deep-vein thrombosis.  Thromb Haemostas . 1993;  69 623
  PubMedGoogle Scholar
• 42 Prandoni P, Lensing A W, Bernardi E. A novel ultrasound protocol for the diagnosis of symptomatic recurrent deep-vein thrombosis.  Haemostasis . 2000;  46 (46)
  PubMedGoogle Scholar
• 43 Hull R D, Hirsh J, Sackett D L. Clinical validity of a negative venogram in patients with clinically suspected deep-vein thrombosis.  Circulation . 1981;  64 622-625
  CrossrefPubMedGoogle Scholar
• 44 Leclerc J R, Illescas F, Jarzem P. Diagnosis of deep vein thrombosis. In: Leclerc JR, ed. Venous Thromboembolic Disorders Philadelphia: Lea & Febiger 2000: 176-228
  Google Scholar
• 45 Bernardi E, Prandoni P, Lensing A WA. D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study.  Br Med J . 1998;  317 1037-1040
  CrossrefPubMedGoogle Scholar