Single whole‐leg compression ultrasound for exclusion of deep vein thrombosis in symptomatic ambulatory patients: a prospective observational cohort study

• Published in: British journal of haematology Vol. 164; no. 3; pp. 422 - 430
• Main Authors: Horner, Daniel, Hogg, Kerstin, Body, Richard, Jones, Steve, Nash, Michael J., Mackway‐Jones, Kevin
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.02.2014
• Subjects: Anticoagulants; anticoagulation; Biological and medical sciences; Cohort Studies; Female; Hematologic and hematopoietic diseases; Humans; imaging; Leg - blood supply; Leg - diagnostic imaging; Male; Medical sciences; Middle Aged; Prospective Studies; thrombosis; Treatment Outcome; Tumors; Ultrasonography - methods; Venous Thrombosis - diagnosis; Venous Thrombosis - diagnostic imaging; whole‐leg compression ultrasound; Human; Compression; Observational study; Hematology; anticoagulation; Deep vein thrombosis; Cardiovascular disease; Anticoagulant; imaging; Venous disease; Leg; whole-leg compression ultrasound; Vascular disease; Prospective; Cancerology; Treatment; thrombosis; Cohort study; Medical imagery; Venous thrombosis; Ambulatory; Ultrasound
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.12642

Summary International guidance has recently recommended serial proximal compression ultrasound (CUS) as first line imaging for suspected deep vein thrombosis (DVT). Single whole‐leg CUS is a routine alternative diagnostic strategy that can reduce repeated attendances and identify alternative pathology. We conducted a prospective observational cohort study. Consecutive ambulatory, adult patients with suspected DVT and negative or inconclusive whole‐leg CUS had anticoagulation withheld and were followed for 3 months. The primary outcome was a predefined clinically relevant adverse event rate. Secondary outcomes included technical failure, alternative diagnoses and all cause mortality. 212 patients agreed to participate and completed follow up. One patient was subsequently diagnosed with an isolated distal DVT. The adverse event rate was thus 1/212, 0·47% (95% confidence interval [CI] 0·08–2·62). Technical imaging failure occurred in 11·3% of cases (95% CI 7·7–16·3). Several potential predictors of an inconclusive result were identified on multivariate analysis. 150 (70·8%) patients were provided with a documented alternative diagnosis. Patients who have anticoagulation withheld following a negative or inconclusive whole‐leg CUS for suspected DVT have a low rate of adverse events. Technical failure remains an issue: several factors were significantly associated with inconclusive results and may warrant an alternative diagnostic approach.