Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins

Viviana Maria Minardi, Sergio Siragusa, Alessandra Malato, Raffaela Anastasio, Paola Tatoni, Katerina Granzow, Stefano Pirrelli, Piernicola Palmieri, Guglielmo Mariani, Gabriella Gamba, Francesco Falaschi, Maria Antonietta Bressan, Camillo Porta

Risultato della ricerca: Article

19 Citazioni (Scopus)

Abstract

Background: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. Methods: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. Results: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. Conclusion: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.
Lingua originaleEnglish
pagine (da-a)2477-2482
Numero di pagine6
RivistaArchives of Internal Medicine
Volume164
Stato di pubblicazionePublished - 2004

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cita questo

Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins. / Minardi, Viviana Maria; Siragusa, Sergio; Malato, Alessandra; Anastasio, Raffaela; Tatoni, Paola; Granzow, Katerina; Pirrelli, Stefano; Palmieri, Piernicola; Mariani, Guglielmo; Gamba, Gabriella; Falaschi, Francesco; Bressan, Maria Antonietta; Porta, Camillo.

In: Archives of Internal Medicine, Vol. 164, 2004, pag. 2477-2482.

Risultato della ricerca: Article

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title = "Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins",
abstract = "Background: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. Methods: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. Results: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8{\%} (95{\%} confidence interval [CI], 20.3{\%}-27.3{\%}) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2{\%}; upper 95{\%} CI, 0.6{\%}) had occurred, whereas at the 3-month follow-up, 5 events (1.2{\%}; 95{\%} CI, 0.2{\%}-2.1{\%}) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. Conclusion: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.",
author = "Minardi, {Viviana Maria} and Sergio Siragusa and Alessandra Malato and Raffaela Anastasio and Paola Tatoni and Katerina Granzow and Stefano Pirrelli and Piernicola Palmieri and Guglielmo Mariani and Gabriella Gamba and Francesco Falaschi and Bressan, {Maria Antonietta} and Camillo Porta",
year = "2004",
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pages = "2477--2482",
journal = "JAMA Internal Medicine",
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TY - JOUR

T1 - Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins

AU - Minardi, Viviana Maria

AU - Siragusa, Sergio

AU - Malato, Alessandra

AU - Anastasio, Raffaela

AU - Tatoni, Paola

AU - Granzow, Katerina

AU - Pirrelli, Stefano

AU - Palmieri, Piernicola

AU - Mariani, Guglielmo

AU - Gamba, Gabriella

AU - Falaschi, Francesco

AU - Bressan, Maria Antonietta

AU - Porta, Camillo

PY - 2004

Y1 - 2004

N2 - Background: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. Methods: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. Results: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. Conclusion: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.

AB - Background: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. Methods: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. Results: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. Conclusion: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.

UR - http://hdl.handle.net/10447/18945

M3 - Article

VL - 164

SP - 2477

EP - 2482

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

ER -