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Low Accuracy of Color Doppler Ultrasound in the Detection of Proximal Leg Vein Thrombosis in Asymptomatic High-Risk Patients

Bruce L. Davidson, MD, MPH; C. Gregory Elliott, MD; Anthonie W. A. Lensing, MD, PhD, RD Heparin Arthroplasty Group*>
[+] Article and Author Information

Grant Support: In part by Wyeth-Ayerst Research.

Requests for Reprints: Bruce L. Davidson, MD, MPH, Wyeth-Ayerst Research, P. O. Box 8299, Philadelphia, PA 19101.

Current Author Addresses: Dr. Davidson: Wyeth-Ayerst Research, P. O. Box 8299, Philadelphia, PA 19101.

Dr. Elliott: Pulmonary Division, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143.

Dr. Lensing: Academic Medical Center, Meibergdreef 9, Center for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, 1105 A2 Amsterdam, The Netherlands.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;117(9):735-738. doi:10.7326/0003-4819-117-9-735
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Objective: To evaluate the ability of color Doppler ultrasound to detect proximal deep venous thrombosis (DVT) in asymptomatic high-risk patients who subsequently underwent contrast venography.

Design: Prospective cohort study using blinded observers, with contrast venography as the comparison standard.

Setting: Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT.

Patients: A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement.

Measurements: Ten days after surgery or before hospital discharge (whichever occurred first), patients had bilateral color Doppler ultrasound examinations of the proximal veins of the lower extremities. Subsequently, a contrast venogram of the operated leg was obtained.

Results: Color Doppler ultrasound studies and venograms were both evaluable in 319 of the 385 patients. Deep venous thrombosis was identified by contrast venography in 80 patients (prevalence, 25%; 95% Cl, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; Cl, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; Cl, 18% to 62%), moderately good specificity (92%; Cl, 89% to 95%), and a poor positive predictive value for this population (26%).

Conclusion: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.

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