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Serial Impedance Plethysmography in Pregnant Patients with Clinically Suspected Deep-Vein Thrombosis: Clinical Validity of Negative Findings

Russell D. Hull, MBBS, MSC; Gary E. Raskob, MSC; and Cedric J. Carter, MBBS
[+] Article, Author, and Disclosure Information

Grant Support: Supported by grants from the Ontario Ministry of Health, the Heart and Stroke Foundation of Ontario, and the Canadian Heart Foundation.

Requests for Reprints: Russell D. Hull, MBBS, MSc, The University of Calgary, Department of Medicine, Foothills Hospital, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada.

Current Author Addresses: Dr. Hull and Mr. Raskob: The University of Calgary, Department of Medicine, Foothills Hospital, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada. Dr. Carter: Department of Pathology, University Hospital—UBC Site, 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(9):663-667. doi:10.7326/0003-4819-112-9-663
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Study Objective: To determine the safety of withholding anticoagulant therapy in pregnant patients with clinically suspected deep-vein thrombosis who have negative results by serial impedance plethysmography.

Design: Prospective study evaluating prognosis by long-term follow-up to 3 months postpartum in all patients.

Setting: University-affiliated community hospital and referral center.

Patients: One hundred fifty-two consecutive pregnant patients referred with clinically suspected deep-vein thrombosis. All patients completed the study.

Interventions: Anticoagulant therapy was withheld in 139 patients negative by serial impedance plethysmography, and the patients were followed long term.

Measurements and Main Results: None of 139 patients (0%; 95% CI, 0% to 2.6%) had symptomatic pulmonary embolism or recurrent venous thrombosis.

Conclusions: The findings establish the safety of withholding anticoagulant therapy in pregnant patients who have negative results after serial impedance plethysmography. Sufficient patients were entered to provide narrow confidence intervals on the outcomes observed in patients with negative findings by impedance plethysmography. These findings are similar to those seen after venography in symptomatic patients. These data extend the role of non-invasive testing in patients with clinically suspected deep-vein thrombosis to the pregnant symptomatic patient.





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