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Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins.
Arch Intern Med. 2004 Dec 13-27; 164(22):2477-82.AI

Abstract

BACKGROUND

Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined.

METHODS

Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism.

RESULTS

In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients.

CONCLUSION

Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.

Authors+Show Affiliations

Thrombosis and Hemostasis Unit, Division of Haematology, University of Palermo, Palermo, Italy. sergio.siragusa@tiscali.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15596639

Citation

Siragusa, Sergio, et al. "Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of Thrombosis: a Practical Approach Based On the Pretest Clinical Model, D-dimer Testing, and the Use of Low-molecular-weight Heparins." Archives of Internal Medicine, vol. 164, no. 22, 2004, pp. 2477-82.
Siragusa S, Anastasio R, Porta C, et al. Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins. Arch Intern Med. 2004;164(22):2477-82.
Siragusa, S., Anastasio, R., Porta, C., Falaschi, F., Pirrelli, S., Palmieri, P., Gamba, G., Granzow, K., Malato, A., Minardi, V., Tatoni, P., Bressan, M. A., & Mariani, G. (2004). Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins. Archives of Internal Medicine, 164(22), 2477-82.
Siragusa S, et al. Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of Thrombosis: a Practical Approach Based On the Pretest Clinical Model, D-dimer Testing, and the Use of Low-molecular-weight Heparins. Arch Intern Med. 2004 Dec 13-27;164(22):2477-82. PubMed PMID: 15596639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins. AU - Siragusa,Sergio, AU - Anastasio,Raffaela, AU - Porta,Camillo, AU - Falaschi,Francesco, AU - Pirrelli,Stefano, AU - Palmieri,Piernicola, AU - Gamba,Gabriella, AU - Granzow,Katerina, AU - Malato,Alessandra, AU - Minardi,Viviana, AU - Tatoni,Paola, AU - Bressan,Maria Antonietta, AU - Mariani,Guglielmo, PY - 2004/12/15/pubmed PY - 2005/1/22/medline PY - 2004/12/15/entrez SP - 2477 EP - 82 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 164 IS - 22 N2 - BACKGROUND: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. METHODS: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. RESULTS: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. CONCLUSION: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15596639/Deferment_of_objective_assessment_of_deep_vein_thrombosis_and_pulmonary_embolism_without_increased_risk_of_thrombosis:_a_practical_approach_based_on_the_pretest_clinical_model_D_dimer_testing_and_the_use_of_low_molecular_weight_heparins_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.22.2477 DB - PRIME DP - Unbound Medicine ER -