These clots usually form in the lower leg, thigh, or pelvis, but they can also occur in the arm. What Is Deep Vein Thrombosis (DVT)?ĭeep vein thrombosis (DVT) is when a blood clot forms in a deep vein. Study supervision: Sartori, Favaretto, Conti, Cosmi.Ĭonflict of Interest Disclosures: None reported.People who have cancer now or had cancer in the past have a higher risk of getting a blood clot in a vein, which is a serious health problem. Study concept and design: Sartori, Favaretto, Cosmi.Īcquisition, analysis, or interpretation of data: Sartori, Migliaccio, Favaretto, Brusi, Conti, Rodorigo.ĭrafting of the manuscript: Sartori, Favaretto, Cosmi.Ĭritical revision of the manuscript for important intellectual content: Sartori, Migliaccio, Brusi, Conti, Rodorigo.Īdministrative, technical, or material support: Migliaccio, Rodorigo. doi: 10.1001/jamainternmed.2015.1683.Īuthor Contributions : Drs Sartori and Cosmi had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Orsola-Malpighi University Hospital, Via Albertoni, 15, 40138 Bologna, Italy ( Online: May 11, 2015. Our data suggest that anticoagulation can be safely withheld on the basis of ultrasonographic screening for suspected UE-DVT.Ĭorresponding Author: Michelangelo Sartori, MD, PhD, Department of Angiology and Blood Coagulation, S. The electronic medical record was consulted for these 5 patients at the end of the follow-up period and no hospitalizations for PE and/or DVT were found. Our study was performed in a single center, with enrollment limited to business hours, and 5 patients (1.5%) with normal ultrasonographic findings were lost to follow-up. With our approach, more initial ultrasonographies were performed, but they were repeated in only 4.3% of patients. ![]() Repeated testing involves greater resource use and more discomfort for patients, some of whom are not willing to return for a second test. 6 The proposed diagnostic algorithm for suspected UE-DVT with D-dimer in a recent study 3 was designed to limit ultrasonographies, but 373 were performed in 402 patients because 14.3% patients repeated the ultrasonographic screening. No prospective management study for suspected UE-DVT is available in which anticoagulation is withheld only on the basis of ultrasound. 4 Venography is the criterion standard for diagnosis of UE-DVT, 5 but it has been largely replaced by ultrasonography in clinical practice. Our study shows that, similar to that of the lower extremities, a completely normal finding on ultrasonography of the upper extremity can safely exclude DVT. Written informed consent was obtained for all patients. This study was approved by the local Ethics Committee of Bologna University Hospital, Italy. ![]() Participants who were lost to follow-up were removed a priori from the analysis. All events were adjudicated by one of us (B.C.) who was not involved in patient enrollment or follow-up. The outcome was the cumulative 3-month incidence of objectively confirmed symptomatic PE and/or UE-DVT. Patients with DVT or SVT received anticoagulants while patients with either negative or initially inconclusive findings from the ultrasonographic screening were not treated and were followed up for 3 months. We enrolled eligible consecutive patients during business days. Exclusion criteria were age younger than 18 years, pregnancy or puerperium, PE symptoms, life expectancy of less than 3 months, and a need for anticoagulant therapy or anticoagulation lasting more than 48 hours.
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