Birdwell B G, Raskob G E, Whitsett T L, Durica S S, Comp P C, George J N, Tytle T L, McKee P A
Veterans Administration Medical Center, Oklahoma City, OK 73104, USA.
Ann Intern Med. 1998 Jan 1;128(1):1-7. doi: 10.7326/0003-4819-128-1-199801010-00001.
Ultrasonography using vein compression accurately detects proximal deep venous thrombosis in symptomatic outpatients. Repeated testing is required for patients with normal results at presentation, but the optimal management of such patients is uncertain.
To test the safety of withholding anticoagulation in outpatients suspected of having first-episode deep venous thrombosis who have normal results on simplified compression ultrasonography at presentation and on a single repeated test done 5 to 7 days later.
Prospective cohort study.
Noninvasive vascular laboratories at a university teaching hospital and a Veterans Administration medical center.
405 consecutive outpatients suspected of having first-episode deep venous thrombosis.
Ultrasonography was performed at presentation. The common femoral and popliteal veins were assessed for compressibility. If the result was normal, anti-coagulation was withheld and testing was repeated 5 to 7 days later. Anticoagulation was withheld from all patients whose results remained normal according to compression ultrasonography, regardless of their symptoms. The safety of this approach was tested by follow-up lasting 3 months.
Objective testing was done during follow-up in all patients with symptoms or signs of venous thromboembolism. The outcome measure was symptomatic venous thrombosis or pulmonary embolism during follow-up, confirmed by objective testing.
Ultrasonography had normal results in 335 patients (83%) and abnormal results in 70 (17%). None of the patients with normal results died of pulmonary embolism. Venous thromboembolism occurred during follow-up in 2 patients with normal ultrasonographic results (0.6% [95% CI, 0.07% to 2.14%]) and in 4 patients with abnormal results (5.7% [CI, 1.58% to 13.99%]) (P = 0.009).
It is safe to withhold anticoagulation in outpatients suspected of having first-episode deep venous thrombosis if results of simplified compression ultrasonography are normal at presentation and on a single repeated test done 5 to 7 days later.
使用静脉压迫的超声检查能准确检测有症状门诊患者的近端深静脉血栓形成。初诊结果正常的患者需要重复检测，但此类患者的最佳管理方式尚不确定。
检测对于疑似首次发生深静脉血栓形成且初诊及5至7天后单次重复检测时简化压迫超声检查结果均正常的门诊患者，暂不进行抗凝治疗的安全性。
前瞻性队列研究。
一所大学教学医院和一家退伍军人管理局医疗中心的无创血管实验室。
405例连续的疑似首次发生深静脉血栓形成的门诊患者。
初诊时进行超声检查。评估股总静脉和腘静脉的可压缩性。如果结果正常，则暂不进行抗凝治疗，并在5至7天后重复检测。根据压迫超声检查结果，所有结果仍正常的患者，无论其症状如何，均暂不进行抗凝治疗。通过为期3个月的随访来检测该方法的安全性。
对所有有静脉血栓栓塞症状或体征的患者在随访期间进行客观检测。结局指标为随访期间经客观检测证实的有症状静脉血栓形成或肺栓塞。
335例患者（83%）超声检查结果正常，70例（17%）结果异常。结果正常的患者均未死于肺栓塞。超声检查结果正常的2例患者（0.6% [95% CI，0.07%至2.14%]）和结果异常的4例患者（5.7% [CI，1.58%至13.99%]）在随访期间发生了静脉血栓栓塞（P = 0.009）。
对于疑似首次发生深静脉血栓形成的门诊患者，如果初诊及5至7天后单次重复检测时简化压迫超声检查结果均正常，则暂不进行抗凝治疗是安全的。
