Clinical relevance of distal deep vein thrombosis

Article Article scientifique Revue de la littérature Clinical relevance of distal deep vein thrombosis eng 2005-12-12 2006-01 author Righini Marc Philip 0000-0003-1211-2969 38989 Département de médecine (DEMED) author Paris Samuel 510491 author Le Gal Grégoire author Laroche Jean-Pierre author Perrier Arnaud 27944 Décanat et administration de la faculté de médecine (ADMED) author Bounameaux Henri 25481 Décanat et administration de la faculté de médecine (ADMED) 56-64 10.1160/th05-08-0588 16543962 0340-6245 http://www.thieme-connect.de/DOI/DOI?10.1160/TH05-08-0588 The standard diagnostic approach of suspected deep vein thrombosis (DVT) is serial lower limb compression ultrasound (CUS) of proximal veins. Although it only assesses the proximal veins, withholding anticoagulant treatment in patients with a negative CUS on day one and after one week has been proven to be safe. However, in many centres, distal DVT is systematically screened for and treated by anticoagulants. The objectives of the review were 1) to evaluate the rate of extension of distal DVTs to proximal veins 2) to compare the safety of proximal limited CUS versus single complete CUS. We performed a MEDLINE search covering the period from January 1983 to January 2005 by using the key-words “calf vein thrombosis”, “distal thrombosis” and “compression ultrasonography”. English, German and French language original studies were retrieved. Moreover, references of retrieved articles were screened in order to detect missed pertinent articles. We pooled data of management studies where proximal or complete (i. e. proximal and distal) CUS were used, respectively. Studies evaluating CUS limited to the proximal veins showed a good safety profile with a pooled estimate of the 3-month thromboembolic rate of 0.6% (95% CI: 0.4–0.9%) in patients in whom anticoagulation was withheld. Studies using proximal and distal CUS showed a similar pooled estimate of the 3-month thromboembolic rate (0.4%, 95% CI: 0.1–0.6%) but distal DVT accounted for as many as 50% of all diagnosed DVTs in those series. Therefore, searching for distal DVT potentially doubles the number of patients given anticoagulant therapy and entails a risk of over-treatment. Data suggesting that anticoagulation is indicated for distal DVT are limited, and realizing distal CUS entails a risk of over-treatment. There is an urgent need for randomised trials assessing the usefulness of anticoagulant treatment in distal DVT. Calf thrombosis Distal deep vein thrombosis Compression ultra- sonography Proximal deep vein thrombosis Dewey 616 Swiss National Science Foundation Utilité de l'anticoagulation en cas de TVP distale isolée symptomatique 105991 CH Projects 56 Département de médecine 221 false 477 Maladie thromboembolique veineuse 808 Thrombosis and haemostasis 95 01 9ca48cb5-4480-4d3e-8029-64fbbec52b23 Article (Published version) Public Article_scientifique_from_crossref.pdf 245326 application/pdf 81b9b40d81548918507d38533cb4a7b8464973b143e5f4c157e9b7d23155a9c9 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

Title	Published in	Year	Views	Downloads

Thromboses veineuses profondes distales symptomatiques : un dilemme diagnostique et thérapeutique		2006	2,565	6,307
Clinical relevance of distal deep vein thrombosis	Thrombosis and haemostasis	2006	44	195

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Paris, Samuel