The Diagnostic Management of Recurrent Deep Vein Thrombosis and Pulmonary Embolism

Melanie Tan; Gerben Mol; Jan Kees van Rooden; Menno V. Huisman

doi:10.1055/s-0032-1311798

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2012; 33(02): 151-155
DOI: 10.1055/s-0032-1311798

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Diagnostic Management of Recurrent Deep Vein Thrombosis and Pulmonary Embolism

Melanie Tan

¹Department of Thrombosis and Haemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands.

,

Gerben Mol

²Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands.

,

Jan Kees van Rooden

³Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.

,

Menno V. Huisman

¹Department of Thrombosis and Haemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands.

› Author Affiliations

Abstract

The diagnostic management of recurrent venous thromboembolism (VTE) is a clinical dilemma. Clinical decision rules are well validated in patients with a first episode of clinically suspected VTE but are not validated in patients with a suspected recurrent event. D-dimer testing could safely exclude a recurrent VTE but is subject to several limitations. Imaging could objectively exclude or establish the diagnosis of recurrent VTE, but due to persistent residual abnormalities after the first or previous event, imaging interpretation can be difficult. To limit the presence of uncertain imaging test results, a standardized baseline examination after anticoagulation cessation should be considered. This review will elaborate on these issues and will discuss the recent advancements in this area.

Keywords

diagnosis - venous thromboembolism - recurrent

Full Text

References

References
1 Huisman MV. Recurrent venous thromboembolism: diagnosis and management. Curr Opin Pulm Med 2000; 6 (4) 330-334
2 Kahn SR. Frequency and determinants of the postthrombotic syndrome after venous thromboembolism. Curr Opin Pulm Med 2006; 12 (5) 299-303
3 Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med 2005; 143 (2) 129-139
4 Wells PS, Anderson DR, Bormanis J , et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350 (9094) 1795-1798
5 Wells PS, Anderson DR, Rodger M , et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349 (13) 1227-1235
6 Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis?. JAMA 2006; 295 (2) 199-207
7 Aguilar C, del Villar V. Combined D-dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis. Am J Hematol 2007; 82 (1) 41-44
8 Klok FA, Tijmensen JE, Haeck ML, van Kralingen KW, Huisman MV. Persistent dyspnea complaints at long-term follow-up after an episode of acute pulmonary embolism: results of a questionnaire. Eur J Intern Med 2008; 19 (8) 625-629
9 Wells PS, Ginsberg JS, Anderson DR , et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998; 129 (12) 997-1005
10 Wells PS, Anderson DR, Rodger M , et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83 (3) 416-420
11 Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001; 161 (1) 92-97
12 Kruip MJ, Leclercq MG, van der Heul C, Prins MH, Büller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies: a systematic review. Ann Intern Med 2003; 138 (12) 941-951
13 Rathbun SW, Whitsett TL, Raskob GE. Negative D-dimer result to exclude recurrent deep venous thrombosis: a management trial. Ann Intern Med 2004; 141 (11) 839-845
14 Le Gal G, Righini M, Roy PM , et al. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med 2006; 166 (2) 176-180
15 Bruinstroop E, van de Ree MA, Huisman MV. The use of D-dimer in specific clinical conditions: a narrative review. Eur J Intern Med 2009; 20 (5) 441-446
16 Aguilar C, Del Villar V. Diagnostic value of D-dimer in outpatients with suspected deep venous thrombosis receiving oral anticoagulation. Blood Coagul Fibrinolysis 2007; 18 (3) 253-257
17 Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 2005; 5: 6
18 Heijboer H, Jongbloets LM, Büller HR, Lensing AW, ten Cate JW. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis. Acta Radiol 1992; 33 (4) 297-300
19 Prandoni P, Cogo A, Bernardi E , et al. A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Circulation 1993; 88 (4 Pt 1) 1730-1735
20 Murphy TP, Cronan JJ. Evolution of deep venous thrombosis: a prospective evaluation with US. Radiology 1990; 177 (2) 543-548
21 Prandoni P, Lensing AW, Bernardi E, Villalta S, Bagatella P, Girolami A. ; DERECUS Investigators Group. The diagnostic value of compression ultrasonography in patients with suspected recurrent deep vein thrombosis. Thromb Haemost 2002; 88 (3) 402-406
22 Tan M, Velthuis SI, Westerbeek RE, van Rooden CJ, van der Meer FJ, Huisman MV. High percentage of non-diagnostic compression ultrasonography results and the diagnosis of ipsilateral recurrent proximal deep vein thrombosis. J Thromb Haemost 2010; 8 (4) 848-850
23 Linkins LA, Stretton R, Probyn L, Kearon C. Interobserver agreement on ultrasound measurements of residual vein diameter, thrombus echogenicity and Doppler venous flow in patients with previous venous thrombosis. Thromb Res 2006; 117 (3) 241-247
24 Linkins LA, Pasquale P, Paterson S, Kearon C. Change in thrombus length on venous ultrasound and recurrent deep vein thrombosis. Arch Intern Med 2004; 164 (16) 1793-1796
25 Hassen S, Barrellier MT, Seinturier C , et al. High percentage of non-diagnostic compression ultrasonography results and the diagnosis of ipsilateral recurrent proximal deep vein thrombosis: a rebuttal. J Thromb Haemost 2011; 9 (2) 414-416 , author reply 417–418
26 Butler SP, Boyd SJ, Parkes SL, Quinn RJ. Technetium-99m-modified recombinant tissue plasminogen activator to detect deep venous thrombosis. J Nucl Med 1996; 37 (5) 744-748
27 Brighton T, Janssen J, Butler SP. Aging of acute deep vein thrombosis measured by radiolabeled 99mTc-rt-PA. J Nucl Med 2007; 48 (6) 873-878
28 Bates SM, Lister-James J, Julian JA, Taillefer R, Moyer BR, Ginsberg JS. Imaging characteristics of a novel technetium Tc 99m-labeled platelet glycoprotein IIb/IIIa receptor antagonist in patients with acute deep vein thrombosis or a history of deep vein thrombosis. Arch Intern Med 2003; 163 (4) 452-456
29 Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I. Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 2002; 136 (2) 89-98
30 Westerbeek RE, Van Rooden CJ, Tan M , et al. Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost 2008; 6 (7) 1087-1092
31 Nijkeuter M, Hovens MM, Davidson BL, Huisman MV. Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review. Chest 2006; 129 (1) 192-197
32 Donadini MP, Dentali F, Cosmi B , et al. Presence of residual thromboemboli at least six months after a first episode of symptomatic pulmonary embolism: do perfusion scintigraphy and angio-computed tomography agree?. Thromb Haemost 2009; 102 (6) 1287-1289
33 Nijkeuter M, Kwakkel-van Erp H, Söhne M , et al; Christopher Study Investigators. Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge. Thromb Haemost 2007; 97 (6) 944-948
34 Moody AR. Magnetic resonance direct thrombus imaging. J Thromb Haemost 2003; 1 (7) 1403-1409
35 Le Gal G, Kovacs MJ, Carrier M , et al. Validation of a diagnostic approach to exclude recurrent venous thromboembolism. J Thromb Haemost 2009; 7 (5) 752-759