Abstract
| Lingua originale | English |
|---|---|
| pagine (da-a) | 2477-2482 |
| Numero di pagine | 6 |
| Rivista | Archives of Internal Medicine |
| Volume | 164 |
| Stato di pubblicazione | Published - 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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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 -