|
|
 Previous Article | Table of Contents | Next Article 
Blood, 1 May 2002, Vol. 99, No. 9, pp. 3102-3110
HOW I TREAT
How we diagnose and treat deep vein thrombosis
Jack Hirsh and
Agnes Y. Y. Lee
From the Henderson Research Centre, and the Department
of Medicine, McMaster University, Hamilton, Ontario, Canada
Making a diagnosis of deep vein thrombosis (DVT) requires both
clinical assessment and objective testing because the clinical features
are nonspecific and investigations can be either falsely positive or
negative. The initial step in the diagnostic process is to stratify
patients into high-, intermediate-, or low-risk categories using a
validated clinical model. When the clinical probability is intermediate
or high and the venous ultrasound result is positive, acute symptomatic
DVT is confirmed. Similarly, when the probability is low and the
ultrasound result is normal, DVT is ruled out. A low clinical
probability combined with a negative D-dimer result can also be used to
rule out DVT, thereby obviating the need for ultrasonography. In
contrast, when the clinical assessment is discordant with the results
of objective testing, serial venous ultrasonography or venography is
required to confirm or refute a diagnosis of DVT. Once a patient is
diagnosed with an acute DVT, low-molecular-weight heparin (LMWH) is the
agent of choice for initial therapy and oral anticoagulant therapy is
the standard for long-term secondary prophylaxis. Therapy should
continue for at least 3 months; the decision to continue treatment
beyond 3 months is made by weighing the risks of recurrent thrombosis
and anticoagulant-related bleeding, and is influenced by patient
preference. Screening for associated thrombophilia is not indicated
routinely, but should be performed in selected patients whose clinical
features suggest an underlying hypercoagulable state. Several new
anticoagulants with theoretical advantages over existing agents are
undergoing evaluation in phase 3 studies in patients with venous thromboembolism.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
S.I.R. Noble, K. Hood, and I.G. Finlay
The use of long-term low-molecular weight heparin for the treatment of venous thromboembolism in palliative care patients with advanced cancer: a case series of sixty two patients
Palliative Medicine,
September 1, 2007;
21(6):
473 - 476.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Brighton, J. Janssen, and S. P. Butler
Aging of Acute Deep Vein Thrombosis Measured by Radiolabeled 99mTc-rt-PA
J. Nucl. Med.,
June 1, 2007;
48(6):
873 - 878.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Milovic, J. R. Behr, M. Godin, C.-S. J. Hou, K. R. Payer, A. Chandrasekaran, P. R. Russo, R. Sasisekharan, and S. R. Manalis
Monitoring of heparin and its low-molecular-weight analogs by silicon field effect
PNAS,
September 5, 2006;
103(36):
13374 - 13379.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Falanga and L. Zacharski
Deep vein thrombosis in cancer: the scale of the problem and approaches to management
Ann. Onc.,
May 1, 2005;
16(5):
696 - 701.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Oudega, K. G. Moons, and A. W Hoes
Limited value of patient history and physical examination in diagnosing deep vein thrombosis in primary care
Fam. Pract.,
February 1, 2005;
22(1):
86 - 91.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Siragusa, R. Anastasio, C. Porta, F. Falaschi, S. Pirrelli, P. Palmieri, G. Gamba, K. Granzow, A. Malato, V. Minardi, et al.
Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of Thrombosis: A Practical Approach Based on the Pretest Clinical Model, D-Dimer Testing, and the Use of Low-Molecular-Weight Heparins
Arch Intern Med,
December 13, 2004;
164(22):
2477 - 2482.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Prandoni, E. Bernardi, A. Marchiori, A. W A Lensing, M. H Prins, S. Villalta, P. Bagatella, D. Sartor, A. Piccioli, P. Simioni, et al.
The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study
BMJ,
August 28, 2004;
329(7464):
484 - 485.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Alifano, G. Benedetti, and R. Trisolini
Can Low-Molecular-Weight Heparin Improve the Outcome of Patients With Operable Non-Small Cell Lung Cancer?: An Urgent Call for Research
Chest,
August 1, 2004;
126(2):
601 - 607.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Rezende, R. E. Simmonds, and D. A. Lane
Coagulation, inflammation, and apoptosis: different roles for protein S and the protein S-C4b binding protein complex
Blood,
February 15, 2004;
103(4):
1192 - 1201.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Eichinger, E. Minar, C. Bialonczyk, M. Hirschl, P. Quehenberger, B. Schneider, A. Weltermann, O. Wagner, and P. A. Kyrle
D-Dimer Levels and Risk of Recurrent Venous Thromboembolism
JAMA,
August 27, 2003;
290(8):
1071 - 1074.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J.J. van Dongen, M. H. Prins, H. R. Buller, C. Seneviratne, Y. Kupfer, S. Tessler, J. A. Krishnan, M. B. Streiff, B. Cosmi, G. Palareti, et al.
Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism
N. Engl. J. Med.,
July 24, 2003;
349(4):
398 - 400.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Hirsh, V. Fuster, J. Ansell, and J. L. Halperin
American Heart Association/American College of Cardiology Foundation guide to warfarin therapy
J. Am. Coll. Cardiol.,
May 7, 2003;
41(9):
1633 - 1652.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kovacs, M. Rodger, D. R. Anderson, B. Morrow, G. Kells, J. Kovacs, E. Boyle, and P. S. Wells
Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism: A Randomized, Double-Blind, Controlled Trial
Ann Intern Med,
May 6, 2003;
138(9):
714 - 719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. G. Hackam
Long-term, low-intensity warfarin after idiopathic venous thromboembolism
Can. Med. Assoc. J.,
April 29, 2003;
168(9):
1160 - 1161.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Hirsh, V. Fuster, J. Ansell, and J. L. Halperin
American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy
Circulation,
April 1, 2003;
107(12):
1692 - 1711.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sundaram, Y. Qi, Z. Shriver, D. Liu, G. Zhao, G. Venkataraman, R. Langer, and R. Sasisekharan
Rational design of low-molecular weight heparins with improved invivo activity
PNAS,
January 21, 2003;
100(2):
651 - 656.
[Abstract]
[Full Text]
[PDF]
|
|
|
| |
