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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2000 March;19(1):47-51


language: English

Risk factor assessment in the management of patients with suspected deep venous thrombosis

Motykie G. D., Caprini J. A., Arcelus J. I. *, Zebala L. P., Lee C. E., Finke N. M., Tamhane A., Reyna J. J. *

From the Depart­ment of Sur­gery, Evans­ton North­west­ern Health­care, Evans­ton IL (USA)
* Hos­pi­tal de la ­Axarquía, ­Málaga, Spain, and North­west­ern Uni­ver­sity Med­i­cal ­School, Chi­ca­go, IL (USA)


Background. To eval­u­ate the prev­a­lence of throm­bo­sis risk fac­tors in a group of ­patients under­go­ing ­venous ­duplex scan­ning (VDS) and to ­design a risk fac­tor strat­ifi­ca­tion model with the abil­ity to ­improve the diag­nos­tic yield of VDS.
Meth­ods. Risk fac­tor assess­ment and VDS were per­formed on 1,000 ­patients with clin­i­cal­ly sus­pect­ed lower extrem­ity deep vein throm­bo­sis (DVT) and ­patients were divid­ed into two ­groups based upon the out­come of their scan: those with and those with­out con­firmed DVT. Uni­var­i­ate and mul­ti­var­i­ate logis­tic regres­sion anal­y­ses were per­formed in order to deter­mine the sig­nif­i­cance of each risk fac­tor in rela­tion to hav­ing a con­firmed DVT.
­Results. There were 181 ­patients (18.1%) with con­firmed DVT. A prior his­to­ry of DVT/pul­mo­nary embo­lism, malig­nan­cy, prior immo­bil­iza­tion, and age over 70 were the most impor­tant risk fac­tors asso­ciat­ed with hav­ing a DVT con­firmed on VDS. A novel risk fac­tor strat­ifi­ca­tion model was creat­ed uti­liz­ing the odds ­ratios of those fac­tors found to be sig­nif­i­cant and the prev­a­lence of DVT was found to be 92.4% in the high risk cat­e­go­ry, 11.5% in the mod­er­ate risk cat­e­go­ry, and 3.2% in the low risk cat­e­go­ry using this model.
Con­clu­sions. ­Venous ­duplex scan­ning is estab­lished as the screen­ing test of ­choice when one sus­pects the diag­no­sis of DVT ­despite the sig­nif­i­cant cost of per­form­ing and inter­pret­ing the test. We sug­gest that a bet­ter clin­i­cal model uti­liz­ing risk fac­tor assess­ment may be the key to increas­ing the yield rate and cost-effec­tive­ness of VDS by exclud­ing low-risk ­patients from under­go­ing unnec­es­sary test­ing.

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