Validation of a diagnostic approach to exclude recurrent venous thromboembolism

被引:54
作者
Le Gal, G. [2 ,3 ,13 ]
Kovacs, M. J. [4 ]
Carrier, M. [2 ]
Do, K.
Kahn, R. [5 ,6 ]
Wells, P. S. [2 ]
Anderson, D. A. [7 ]
Chagnon, I. [8 ]
Solymoss, S. [5 ]
Crowther, M. [9 ]
Righini, M. [10 ]
Perrier, A. [10 ]
White, R. H. [11 ]
Vickars, L. [12 ]
Rodger, M. [1 ,2 ]
机构
[1] Ottawa Gen Hosp, Div Hematol, Ottawa Hlth Res Inst, Clin Epidemiol Unit, Ottawa, ON K1H 8L6, Canada
[2] Univ Ottawa, Dept Med, Div Hematol, Thrombosis Program, Ottawa, ON, Canada
[3] Brest Univ Hosp, Dept Internal Med & Chest Dis, Brest, France
[4] Univ Western Ontario, Dept Med, Div Hematol, London, ON, Canada
[5] McGill Univ, Dept Med, Montreal, PQ, Canada
[6] McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol & Community Studies, Montreal, PQ H3T 1E2, Canada
[7] Dalhousie Univ, Dept Med, Halifax, NS, Canada
[8] Univ Montreal, Dept Med, Hop Sacre Coeur, Montreal, PQ H3C 3J7, Canada
[9] McMaster Univ, Dept Med, Michael G DeGroote Sch Med, Hamilton, ON, Canada
[10] Univ Hosp Geneva, Dept Internal Med, Geneva, Switzerland
[11] UC Davis Sch Med, Dept Med, Sacramento, CA USA
[12] Univ British Columbia, Dept Med, St Pauls Hosp, Vancouver, BC, Canada
[13] Brest Univ Hosp, EA 3878, Brest, France
关键词
diagnosis; management of disease; outcome study; pulmonary embolism; recurrence; venous thrombosis; DEEP-VEIN-THROMBOSIS; SUSPECTED PULMONARY-EMBOLISM; COMPRESSION ULTRASONOGRAPHY; D-DIMER; CLINICAL VALIDITY; MANAGEMENT; ANTICOAGULANT; UTILITY; RISK;
D O I
10.1111/j.1538-7836.2009.03324.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: The diagnosis of recurrent venous thromboembolism (VTE) is a challenge in clinical practice. Our objective was to evaluate the safety of a diagnostic strategy utilizing comparison of diagnostic test results with baseline imaging results to rule out suspected recurrent VTE. Methods: The REVERSE study was a prospective cohort study whose primary aim was to develop a clinical prediction rule for recurrent VTE. We included and followed patients who completed 5-7 months of anticoagulant therapy after a first unprovoked VTE. Suspected cases of recurrent VTE were assessed according to standardized diagnostic criteria based on comparison of diagnostic test results with those obtained at the time of anticoagulant treatment withdrawal. Results: Out of the 398 suspected events, a recurrent VTE was diagnosed in 106 cases (26.6%) and excluded in 292 cases. In 76 cases (19%), the diagnosis of recurrent VTE was excluded on the basis of the fact that no significant change on diagnostic imaging was detected when compared to baseline imaging. During the ensuing 3 months, six patients received anticoagulant therapy after recurrent VTE was excluded, and two were lost to follow-up. Eight of 284 remaining patients in whom recurrent VTE had been excluded, who were not treated and who were not lost to follow-up were diagnosed with subsequent VTE (3-month risk, 2.8%; 95% confidence interval, 1.4-5.5%). Six of these eight patients with subsequent recurrent VTE had a known superficial or distal thrombosis at the time of initial suspected recurrent VTE. Conclusion: A diagnostic strategy comparing diagnostic test results obtained at the time of the suspected recurrent event with those obtained at baseline can safely and effectively rule out recurrent VTE in a significant proportion of patients. Registered at http://www.clinicaltrials.gov identifier: NCT00261014.
引用
收藏
页码:752 / 759
页数:8
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