Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014

• 作者: Gualtiero Palareti Hanny Maasland Jan Jacques Michiels Janneke Maria Michiels Mildred Lao Wim Moossdorff
• 来源期刊: 世界重症医学杂志
• 学科: 医学
• 关键词: Deep VENOUS THROMBOSIS ULTRASONOGRAPHY Post-thrombotic syndrome ELISA VIDAS D-DIMER Medical elastic stockings ANTICOAGULATION
• 年，卷（期）: 2015,（1）
• 页码范围: 29-39
• 页数: 11页
• 分类号: R

摘要

The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT)should be based on an overall objective post incidence of venous thromboembolism(VTE)of less than 1%during 3 mo follow-up.Compression ultrasonography(CUS)of the leg veins has a negative predictive value(NPV)of 97%-98%indicating the need of repeated CUS testing within one week.A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99%and 100%at a low clinical score of zero.The combination of low clinical score and a less sensitive D-dimer test(Simplify)is not sensitive enough to exclude DVT and VTE in routine daily practice.From prospective clinical research studies it may be concluded that complete recanalization within 3-6 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT.Partial and complete recanalization after 6 to more than 12 mo is usually complicated by reflux due to valve destruction and symptomatic PTS.Reflux seems to be a main determinant for PTS and DVT recurrence,the latter as a main contributing factor in worsening PTS.This hypothesis is supported by the relation between the persistent residual vein thrombosis(RVT=partial recanalization)and the risk of VTE recurrence in prospective studies.Absence of RVT at 3 mo post-DVT and no reflux is predicted to be associated with no recurrence of DVT(1.2%)during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT.The presence or absence of RVT but with reflux at or after 6 mo post-DVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment.To test this hypothesis we designed a prospective DVT and postthrombotic syndrome(PTS)Bridging the Gap Study by addressing at least four unanswered questions in the treatment of DVT and PTS.Which DVT patient has a clear indication for long-term compression stocking therapy to prevent PTS after the initial anticoagul