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Non-invasive diagnosis of venous thromboembolism in outpatients.
Lancet 1999; 353(9148):190-5Lct

Abstract

BACKGROUND

We designed a simple and integrated diagnostic algorithm for acute venous thromboembolism based on clinical probability assessment of deep-vein thrombosis (DVT) or pulmonary embolism (PE), plasma D-dimer measurement, lower-limb venous compression ultrasonography, and lung scan to reduce the need for phlebography and pulmonary angiography.

METHODS

918 consecutive patients presenting at the emergency ward of the Geneva University Hospital, Geneva, Switzerland, and Hôpital Saint-Luc, Montreal, Canada, with clinically suspected venous thromboembolism were entered into a sequential diagnostic protocol. Patients in whom venous thromboembolism was deemed absent were not given anticoagulants and were followed up for 3 months.

FINDINGS

A normal D-dimer concentration (<500 microg/L by a rapid ELISA) ruled out venous thromboembolism in 286 (31%) members of the study cohort, whereas DVT by ultrasonography established the diagnosis in 157 (17%). Lung scan was diagnostic in 80 (9%) of the remaining patients. Venous thromboembolism was also deemed absent in patients with low to intermediate clinical probability of DVT and a normal venous ultrasonography (236 [26%] patients), and in patients with a low clinical probability of PE and a non-diagnostic result on lung scan (107 [12%] patients). Pulmonary angiography and phlebography were done in only 50 (5%) and 2 (<1%) of the patients, respectively. Hence, a non-invasive diagnosis was possible in 866 (94%) members of the entire cohort. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 1.8% (95% CI 0.9-3.1).

INTERPRETATION

A diagnostic strategy combining clinical assessment, D-dimer, ultrasonography, and lung scan gave a non-invasive diagnosis in the vast majority of outpatients with suspected venous thromboembolism, and appeared to be safe.

Authors+Show Affiliations

Medical Clinic 1, Geneva University Hospital, Switzerland. arnaud.perrier@medecine.unige.chNo 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

9923874

Citation

Perrier, A, et al. "Non-invasive Diagnosis of Venous Thromboembolism in Outpatients." Lancet (London, England), vol. 353, no. 9148, 1999, pp. 190-5.
Perrier A, Desmarais S, Miron MJ, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353(9148):190-5.
Perrier, A., Desmarais, S., Miron, M. J., de Moerloose, P., Lepage, R., Slosman, D., ... Bounameaux, H. (1999). Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet (London, England), 353(9148), pp. 190-5.
Perrier A, et al. Non-invasive Diagnosis of Venous Thromboembolism in Outpatients. Lancet. 1999 Jan 16;353(9148):190-5. PubMed PMID: 9923874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive diagnosis of venous thromboembolism in outpatients. AU - Perrier,A, AU - Desmarais,S, AU - Miron,M J, AU - de Moerloose,P, AU - Lepage,R, AU - Slosman,D, AU - Didier,D, AU - Unger,P F, AU - Patenaude,J V, AU - Bounameaux,H, PY - 1999/1/29/pubmed PY - 1999/1/29/medline PY - 1999/1/29/entrez SP - 190 EP - 5 JF - Lancet (London, England) JO - Lancet VL - 353 IS - 9148 N2 - BACKGROUND: We designed a simple and integrated diagnostic algorithm for acute venous thromboembolism based on clinical probability assessment of deep-vein thrombosis (DVT) or pulmonary embolism (PE), plasma D-dimer measurement, lower-limb venous compression ultrasonography, and lung scan to reduce the need for phlebography and pulmonary angiography. METHODS: 918 consecutive patients presenting at the emergency ward of the Geneva University Hospital, Geneva, Switzerland, and Hôpital Saint-Luc, Montreal, Canada, with clinically suspected venous thromboembolism were entered into a sequential diagnostic protocol. Patients in whom venous thromboembolism was deemed absent were not given anticoagulants and were followed up for 3 months. FINDINGS: A normal D-dimer concentration (<500 microg/L by a rapid ELISA) ruled out venous thromboembolism in 286 (31%) members of the study cohort, whereas DVT by ultrasonography established the diagnosis in 157 (17%). Lung scan was diagnostic in 80 (9%) of the remaining patients. Venous thromboembolism was also deemed absent in patients with low to intermediate clinical probability of DVT and a normal venous ultrasonography (236 [26%] patients), and in patients with a low clinical probability of PE and a non-diagnostic result on lung scan (107 [12%] patients). Pulmonary angiography and phlebography were done in only 50 (5%) and 2 (<1%) of the patients, respectively. Hence, a non-invasive diagnosis was possible in 866 (94%) members of the entire cohort. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 1.8% (95% CI 0.9-3.1). INTERPRETATION: A diagnostic strategy combining clinical assessment, D-dimer, ultrasonography, and lung scan gave a non-invasive diagnosis in the vast majority of outpatients with suspected venous thromboembolism, and appeared to be safe. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/9923874/Non_invasive_diagnosis_of_venous_thromboembolism_in_outpatients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(98)05248-9 DB - PRIME DP - Unbound Medicine ER -