alexa Complete Compression Ultrsonography, Clinical Score, Underlying Risk
ISSN: 2329-8790

Journal of Hematology & Thromboembolic Diseases
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Research Article

Complete Compression Ultrsonography, Clinical Score, Underlying Risk

Jan Jacques Michiels1,2,3*, Rob Strijkers4, Janneke M Michiels5, Wim Moossdorff3, Mildred Lao2 and Petr Dulicek6
1Goodheart Institute & Foundation, Bloodcoagulation & Vascular Medicine Science Center, Rotterdam, The Netherlands
2Department of Dermatology, Section Phlebology, Erasmus University Medical Center, Rotterdam, The Netherlands
3Star-Medical Diagnostic Center, Rijnmond Rotterdam, The Netherlands
4Department of Internal Medicine, Haaglanden Hospital, The Hague, The Netherlands
5Primary Care Medicine, Leiden University Medical Center Leiden, The Netherlands
6Department of Internal Medicine- Hematology, University Hospital and Faculty of Medicine in Hradec Kralove and Charles University, Prague, Czech Republic
Corresponding Author : Dr. J.J. Michiels
Senior Internist Investigator Phlebology 2007-2014
Department of Dermatology, Section Phlebology
Erasmus University Medical Center (Erasmus UMC)
Rotterdam and Goodheart Institute & Foundation in Nature Medicin & Health
ErasmusTower, Veenmos 13 3069 AT Rotterdam, The Netherlands
Tel: 00971-554078445
E-mail: [email protected]
Received January 02, 2015; Accepted February 22, 2015; Published February 28, 2015
Citation: Michiels JJ, Strijkers R, Michiels JM, Moossdorff W, Lao M, et al. (2015) Complete Compression Ultrsonography, Clinical Score, Underlying Risk Factors and D-Dimer Testing for Objective Evidence Based Diagnosis and Exclusion of Deep Vein Thrombosis and Alternative Diagnoses in the Primary Care and Hospital Setting. J Hematol Thromb Dis 3:193. doi:10.4172/2329-8790.1000193
Copyright: © 2015 Michiels JJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Superficial vein thrombosis is an integral part of venous thromboembolism (VTE) together with deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence of SVT is 1.6 per 1000 persons per year. The incidence of DVT is about 1.0 per 1000 persons per year in the general population, 1.8 per 1000 persons per year at age 65 to 69 years and 3.1 per 1000 persons per year at age 85 to 89 years. First episodes of DVT are in two-thirds of cases elicited by risk factors, including varicose veins, cancer, pregnancy/ postpartum, oral contraceptives below the age of 50 years, immobility or surgery. Pain and tenderness in the calf and popliteal fossa may occur resulting from other conditions labeled as alternative diagnosis (AD) including Baker’s cyst, ruptured Baker’s cyst, torn plantaris tendon, hematoma, or muscle tears or pulls. The requirement for a safe diagnostic strategy of deep vein thrombosis (DVT) should be based on an objective post-test incidence of venous thromboembolism (VTE) of less than 0.1% with a negative predictive value for exclusion of DVT of 99.99% during 3 months follow-up. Modification of the Wells score by elimination of the “minus 2 points” for AD is mandatory and will improve clinical score assessment for DVT suspicion in the primary care and outpatient medical diagnostic setting. Compression ultrasonography (CUS) for proximal DVT overlooks distal DVT and is not cost-effective enough to rule in or out DVT. Complete CUS (CCUS) does pick up alternative diagnoses (AD) like Bakers cyst, muscle hematomas, old DVT, and superficial vein thrombosis (SVT). ADs with a negative CCUS include leg edema, varices erysipelas are easily picked up by physical examination. The sequential use of CCUS followed by quantitative rapid ELISA-D-dimer testing and modified Wells’ clinical score assessment is cost-effective and objective diagnostic algorithm that can safely and effectively exclude and diagnose both DVT and AD in patients with suspected DVT. About 10 to 30% of patients with DVT develop overt PTS (CEAP, C4,5) at one year post-DVT. DVT has a recurrence rate of about 20% to 30% after 5 years. A scoring system for lower extremity venous thrombosis (LET) extension on CCUS related to therapeutic implications is presented to prevent DVT recurrence and the post-thrombotic syndrome (PTS).

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