Department of Medicine, Intermountain Medical Center, Murray, UT 84157, USA.
Clin Appl Thromb Hemost. 2013 Jan-Feb;19(1):79-85. doi: 10.1177/1076029612445919. Epub 2012 May 14.
Prompt, accurate diagnosis of deep vein thrombosis (DVT) is essential. A single, whole-leg ultrasound (whole-leg US) has been used to exclude DVT, but limited data exist for patients with high pretest probability (PTP) for DVT. This diagnostic management study tested the rate of venous thromboembolism (VTE) in patients with a PTP of "DVT likely" per the simplified Wells score when anticoagulation is withheld based on a single, negative whole-leg US. Consecutive patients presenting during coordinator shifts with a PTP of DVT likely were enrolled. Anticoagulation was withheld after a single, negative whole-leg US. The outcome was objectively confirmed VTE in 3 months. All 167 patients completed the follow-up. A single patient death was adjudicated as possibly caused by VTE, resulting in a VTE rate of 0.60% (95% confidence interval: 0.02%-3.29%). Whole-leg US should be further studied in diagnostic algorithms that utilize PTP scoring and D-dimer testing.
快速、准确地诊断深静脉血栓形成（DVT）至关重要。单次全下肢超声（whole-leg US）已被用于排除 DVT，但对于 DVT 高预测概率（PTP）的患者，相关数据有限。本诊断管理研究在根据简化 Wells 评分预测“DVT 可能性大”的患者中，在单次全下肢 US 阴性时不使用抗凝治疗，以此评估这些患者的静脉血栓栓塞症（VTE）发生率。研究连续纳入在协调员轮班期间就诊、且 DVT 预测概率大的患者。在单次全下肢 US 阴性后，停止抗凝治疗。3 个月后通过客观检查来确认 VTE 。所有 167 例患者均完成了随访。有一例患者死亡被判定可能由 VTE 引起，VTE 发生率为 0.60%（95%置信区间：0.02%-3.29%）。全下肢 US 应该在利用 PTP 评分和 D-二聚体检测的诊断算法中进一步研究。
