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Diagnosis of Deep-Vein Thrombosis Using an Objective Doppler Method

Anthonie W.A. Lensing, MD; Marcel M. Levi, MD; Harry R. Büller, MD, PhD; Paolo Prandoni, MD; Mario Vigo, MD; Giancarlo Agnelli, MD; Luciano Lupatelli, MD; Menno V. Huisman, MD, PhD; and Jan Wouter ten Cate, MD, PhD
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Grant Support: By fellowship grant 86.073 from the Netherlands Heart Foundation (A.W.A.L.), a grant from the "Drie Lichten," the Netherlands, and a fellowship of the Royal Netherlands Academy of Art and Sciences (H.R.B.).

Requests for Reprints: Anthonie W. A. Lensing, MD, Center for Thrombosis, Haemostasis and Atherosclerosis Research, F4 Room 237, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Current Author Addresses: Drs. Lensing, Levi, Büller, Huisman, and ten Cate: Center for Thrombosis, Haemostasis and Atherosclerosis Research, F4, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Drs. Prandoni and Vigo: Institute of Internal Medicine, University of Padua, via Augustini, 3500 Padua, Italy.

Drs. Agnelli and Lupatelli: Institute of Internal Medicine, University of Perugia, Perugia, Italy.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(1):9-13. doi:10.7326/0003-4819-113-1-9
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Study Objective: To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients.

Design: A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers.

Setting: Referral-based medical clinics at university medical centers.

Patients: One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included.

Methods and Measurements: A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results.

Conclusions: The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients.





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