Document Detail

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.
MedLine Citation:
PMID:  15596639     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. METHODS: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. RESULTS: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. CONCLUSION: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.
Sergio Siragusa; Raffaela Anastasio; Camillo Porta; Francesco Falaschi; Stefano Pirrelli; Piernicola Palmieri; Gabriella Gamba; Katerina Granzow; Alessandra Malato; Viviana Minardi; Paola Tatoni; Maria Antonietta Bressan; Guglielmo Mariani
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  164     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:    2004 Dec 13-27
Date Detail:
Created Date:  2004-12-14     Completed Date:  2005-01-21     Revised Date:  2007-11-27    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2477-82     Citation Subset:  AIM; IM    
Thrombosis and Hemostasis Unit, Division of Haematology, University of Palermo, Palermo, Italy.
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MeSH Terms
Aged, 80 and over
Fibrin Fibrinogen Degradation Products / analysis*
Follow-Up Studies
Heparin, Low-Molecular-Weight / therapeutic use*
Middle Aged
Pulmonary Embolism / diagnosis*
Venous Thrombosis / diagnosis*
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/Heparin, Low-Molecular-Weight; 0/fibrin fragment D

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