Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA.
JAMA. 2010 Feb 3;303(5):438-45. doi: 10.1001/jama.2010.43.
In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation.
To determine the risk of venous thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-leg CUS result.
MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts.
Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous thromboembolism events.
Two authors independently reviewed and extracted data regarding a single positive or negative whole-leg CUS result, occurrence of venous thromboembolism during follow-up, and study quality.
Seven studies were included totaling 4731 patients with negative whole-leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous thromboembolism or suspected venous thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%).
Withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk of venous thromboembolism during 3-month follow-up.
在疑似下肢深静脉血栓形成（DVT）的患者中，压缩超声（CUS）通常是用于确认或排除 DVT 的初始检查。初始 CUS 结果为阴性的患者通常需要在 5 至 7 天后重复 CUS。全腿 CUS 可在单次评估中排除近端和远端 DVT。
确定在疑似下肢 DVT 患者单次全腿 CUS 结果阴性后，不进行抗凝治疗，静脉血栓栓塞风险。
从 1970 年 1 月至 2009 年 11 月，对 MEDLINE、EMBASE、CINAHL、LILACS、Cochrane 和卫生技术评估数据库进行了检索，以获取关于疑似 DVT 且全腿 CUS 结果阴性的患者的文章。此外，还对互联网资源、参考文献列表以及通过联系内容专家进行了补充检索。
纳入的研究为随机对照试验和前瞻性队列研究，研究对象为疑似 DVT 且全腿 CUS 结果阴性的患者，他们未接受抗凝治疗，并在至少 90 天的时间内接受静脉血栓栓塞事件随访。
两名作者独立回顾和提取了关于单次全腿 CUS 阳性或阴性结果、随访期间静脉血栓栓塞事件发生情况以及研究质量的数据。
共纳入 7 项研究，共计 4731 例接受全腿 CUS 检查且结果为阴性的患者，他们未接受抗凝治疗。其中，多达 647 例患者（13.7%）患有活动性癌症，多达 725 例患者（15.3%）近期接受了大手术。大多数参与者来自门诊。34 例患者（0.7%）发生静脉血栓栓塞或疑似静脉血栓栓塞相关死亡，包括 11 例远端 DVT（32.4%）；7 例近端 DVT（20.6%）；7 例非致命性肺栓塞（20.6%）；9 例患者（26.5%）死亡，可能与静脉血栓栓塞有关。使用具有倒数方差加权的随机效应模型，3 个月时的静脉血栓栓塞事件率为 0.57%（95%置信区间，0.25%-0.89%）。
在疑似下肢深静脉血栓形成患者中，全腿 CUS 结果阴性后，不进行抗凝治疗，在 3 个月的随访期间，静脉血栓栓塞的风险较低。
