Validation of a diagnostic approach to exclude recurrent venous thromboembolism

G. Le Gal, M. J. Kovacs, M. Carrier, K. Do, S. R. Kahn, P. S. Wells, D. A. Anderson, I. Chagnon, S. Solymoss, M. Crowther, M. Righini, A. Perrier, Richard H White, L. Vickars, Marc Rodger

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)752-759
Number of pages8
JournalJournal of Thrombosis and Haemostasis
Volume7
Issue number5
DOIs
StatePublished - 2009

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Venous Thromboembolism
Routine Diagnostic Tests
Anticoagulants
Lost to Follow-Up
Decision Support Techniques
Diagnostic Imaging
Thrombosis
Cohort Studies
Therapeutics

Keywords

  • Diagnosis
  • Management of disease
  • Outcome study
  • Pulmonary embolism
  • Recurrence
  • Venous thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

Le Gal, G., Kovacs, M. J., Carrier, M., Do, K., Kahn, S. R., Wells, P. S., ... Rodger, M. (2009). Validation of a diagnostic approach to exclude recurrent venous thromboembolism. Journal of Thrombosis and Haemostasis, 7(5), 752-759. https://doi.org/10.1111/j.1538-7836.2009.03324.x

Validation of a diagnostic approach to exclude recurrent venous thromboembolism. / Le Gal, G.; Kovacs, M. J.; Carrier, M.; Do, K.; Kahn, S. R.; Wells, P. S.; Anderson, D. A.; Chagnon, I.; Solymoss, S.; Crowther, M.; Righini, M.; Perrier, A.; White, Richard H; Vickars, L.; Rodger, Marc.

In: Journal of Thrombosis and Haemostasis, Vol. 7, No. 5, 2009, p. 752-759.

Research output: Contribution to journalArticle

Le Gal, G, Kovacs, MJ, Carrier, M, Do, K, Kahn, SR, Wells, PS, Anderson, DA, Chagnon, I, Solymoss, S, Crowther, M, Righini, M, Perrier, A, White, RH, Vickars, L & Rodger, M 2009, 'Validation of a diagnostic approach to exclude recurrent venous thromboembolism', Journal of Thrombosis and Haemostasis, vol. 7, no. 5, pp. 752-759. https://doi.org/10.1111/j.1538-7836.2009.03324.x
Le Gal, G. ; Kovacs, M. J. ; Carrier, M. ; Do, K. ; Kahn, S. R. ; Wells, P. S. ; Anderson, D. A. ; Chagnon, I. ; Solymoss, S. ; Crowther, M. ; Righini, M. ; Perrier, A. ; White, Richard H ; Vickars, L. ; Rodger, Marc. / Validation of a diagnostic approach to exclude recurrent venous thromboembolism. In: Journal of Thrombosis and Haemostasis. 2009 ; Vol. 7, No. 5. pp. 752-759.
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abstract = "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.",
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AU - Le Gal, G.

AU - Kovacs, M. J.

AU - Carrier, M.

AU - Do, K.

AU - Kahn, S. R.

AU - Wells, P. S.

AU - Anderson, D. A.

AU - Chagnon, I.

AU - Solymoss, S.

AU - Crowther, M.

AU - Righini, M.

AU - Perrier, A.

AU - White, Richard H

AU - Vickars, L.

AU - Rodger, Marc

PY - 2009

Y1 - 2009

N2 - 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.

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KW - Diagnosis

KW - Management of disease

KW - Outcome study

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KW - Recurrence

KW - Venous thrombosis

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