Ramsay L E
Br Med J (Clin Res Ed). 1983 Feb 26;286(6366):698-9. doi: 10.1136/bmj.286.6366.698.
In general medical patients presenting with suspected deep vein thrombosis routine use of x ray venography was associated with a large fall in the proportion of patients with a final diagnosis of deep vein thrombosis, from 83% to 25% (p less than 0.001), and with an appreciable shortening of hospital stay, from 13.6 to 7.2 days. The diagnosis of deep vein thrombosis was rejected in only 4% of patients when a venogram was not performed, and it is estimated that two patients were treated with anticoagulants unnecessarily for every patient treated correctly. The risk, expense, and inconvenience of unnecessary anticoagulant treatment far exceeds the risk, expense, and inconvenience of performing venograms routinely. The common practice of misdiagnosing deep vein thrombosis clinically should be abandoned.
一般而言，对于疑似深静脉血栓形成的普通内科患者，常规使用X线静脉造影会使最终诊断为深静脉血栓形成的患者比例大幅下降，从83%降至25%（P<0.001），并使住院时间明显缩短，从13.6天减至7.2天。在未进行静脉造影的患者中，只有4%的患者深静脉血栓形成的诊断被排除，据估计，每正确治疗一名患者，就有两名患者接受了不必要的抗凝治疗。不必要的抗凝治疗的风险、费用和不便远远超过常规进行静脉造影的风险、费用和不便。临床上误诊深静脉血栓形成的常见做法应予以摒弃。
