Circulation, Vol 64, 622-625, Copyright © 1981 by American Heart Association
R Hull, J Hirsh, DL Sackett, DW Taylor, C Carter, AG Turpie, P Powers and M Gent
Although it is generally accepted that negative venography excludes deep
vein thrombosis (DVT) in patients in whom it is clinically suspected, there
is no evidence to support this conclusion. To test the correctness of
withholding anticoagulant therapy in these patients, we followed 160
consecutive patients who had clinically suspected DVT and negative
venograms to determine the frequency of postvenographic DVT. Anticoagulant
therapy was withheld in all patients. No patient died or developed
pulmonary embolism during 3 months of follow-up. Two of the 160 patients
(1.3%) attended the clinic on an emergency basis during follow-up with new
symptoms of DVT and in both patients, DVT was confirmed by objective
testing. These events developed within 5 days of venography, which suggests
that they were induced by venography. Nevertheless, the findings indicate
it is safe to withhold treatment in patients with clinically suspected DVT
and negative venograms.
ARTICLES
Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis
This article has been cited by other articles:
 |
|
 |
|
  E. Coss, J. B. Geske, and P. S. Mueller 57-Year-Old Woman With Acute Lower Extremity Pain and Swelling Mayo Clin. Proc., October 1, 2009; 84(10): e1 - e4. [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Schellong, H. Bounameaux, and H. R. Büller CHAPTER 37 Venous Thromboembolism ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Hanslik, K. Thom, M. Haumer, E. Kitzmuller, S. Albinni, M. Wolfsberger, U. Salzer-Muhar, and C. Male Incidence and Diagnosis of Thrombosis in Children With Short-Term Central Venous Lines of the Upper Venous System Pediatrics, December 1, 2008; 122(6): 1284 - 1291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Dewar and M Corretge Interrater reliability of the Wells score as part of the assessment of DVT in the emergency department: agreement between consultant and nurse practitioner Emerg. Med. J., July 1, 2008; 25(7): 407 - 410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Dewar, C Selby, K Jamieson, and S Rogers Emergency department nurse-based outpatient diagnosis of DVT using an evidence-based protocol Emerg. Med. J., July 1, 2008; 25(7): 411 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Goodacre, M. Stevenson, A. Wailoo, F. Sampson, A.J. Sutton, and S. Thomas How should we diagnose suspected deep-vein thrombosis? QJM, June 1, 2006; 99(6): 377 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Taffoni, J. G. Ravenel, and S. J. Ackerman Prospective Comparison of Indirect CT Venography Versus Venous Sonography in ICU Patients Am. J. Roentgenol., August 1, 2005; 185(2): 457 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Hull Revisiting the Past Strengthens the Present: An Evidence-Based Medicine Approach for the Diagnosis of Deep Venous Thrombosis Ann Intern Med, April 5, 2005; 142(7): 583 - 585. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Lockhart, H. I. Sheldon, and M. L. Robbin Augmentation in Lower Extremity Sonography for the Detection of Deep Venous Thrombosis Am. J. Roentgenol., February 1, 2005; 184(2): 419 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Rathbun, T. L. Whitsett, and G. E. Raskob Negative D-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial Ann Intern Med, December 7, 2004; 141(11): 839 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. McGuire and P. P. Dobesh Therapeutic Update on the Prevention and Treatment of Venous Thromboembolism Journal of Pharmacy Practice, October 1, 2004; 17(5): 289 - 307. [Abstract] [PDF]
|
|
|
|
 |
|
 B. K. Zierler Ultrasonography and Diagnosis of Venous Thromboembolism Circulation, March 30, 2004; 109(12_suppl_1): I-9 - I-14. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. Kelly and B. J. Hunt A Clinical Probability Assessment and D-dimer Measurement Should Be the Initial Step in the Investigation of Suspected Venous Thromboembolism Chest, September 1, 2003; 124(3): 1116 - 1119. [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Stein, R. D. Hull, K. C. Patel, R. E. Olson, W. A. Ghali, A. K. Alshab, and F. A. Meyers Venous Thromboembolic Disease: Comparison of the Diagnostic Process in Blacks and Whites Arch Intern Med, August 11, 2003; 163(15): 1843 - 1848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Stein, R. D. Hull, K. C. Patel, R. E. Olson, W. A. Ghali, A. K. Alshab, and F. A. Meyers Venous Thromboembolic Disease: Comparison of the Diagnostic Process in Men and Women Arch Intern Med, July 28, 2003; 163(14): 1689 - 1694. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Stein, R. D. Hull, W. A. Ghali, K. C. Patel, R. E. Olson, F. A. Meyers, and N. K. Kalra Tracking the Uptake of Evidence: Two Decades of Hospital Practice Trends for Diagnosing Deep Vein Thrombosis and Pulmonary Embolism Arch Intern Med, May 26, 2003; 163(10): 1213 - 1219. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, C. Kearon, M. Crowther, L. Linkins, M. O'Donnell, J. Douketis, A. Y.Y. Lee, J. I. Weitz, M. Johnston, and J. S. Ginsberg A Diagnostic Strategy Involving a Quantitative Latex D-Dimer Assay Reliably Excludes Deep Venous Thrombosis Ann Intern Med, May 20, 2003; 138(10): 787 - 794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, J. Lister-James, J. A. Julian, R. Taillefer, B. R. Moyer, and J. S. Ginsberg 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, February 24, 2003; 163(4): 452 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J.L. van Strijen, W. de Monye, J. Schiereck, G. J. Kieft, M. H. Prins, M. V. Huisman, P. M.T. Pattynama, and for the Advances in New Technologies Evaluating th Single-Detector Helical Computed Tomography as the Primary Diagnostic Test in Suspected Pulmonary Embolism: A Multicenter Clinical Management Study of 510 Patients Ann Intern Med, February 18, 2003; 138(4): 307 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Bates and J. S. Ginsberg How we manage venous thromboembolism during pregnancy Blood, November 15, 2002; 100(10): 3470 - 3478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kelly, A. Rudd, R. R. Lewis, and B. J. Hunt Plasma D-Dimers in the Diagnosis of Venous Thromboembolism Arch Intern Med, April 8, 2002; 162(7): 747 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, A. Grand'Maison, M. Johnston, I. Naguit, M. J. Kovacs, and J. S. Ginsberg A Latex D-Dimer Reliably Excludes Venous Thromboembolism Arch Intern Med, February 12, 2001; 161(3): 447 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Duwe, M. Shiau, N. E. Budorick, J. H. M. Austin, and Y. M. Berkmen Evaluation of the Lower Extremity Veins in Patients with Suspected Pulmonary Embolism: A Retrospective Comparison of Helical CT Venography and Sonography Am. J. Roentgenol., December 1, 2000; 175(6): 1525 - 1531. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, R. F. Brant, G. F. Pineo, G. Elliott, P. D. Stein, A. Gottschalk, K. A. Valentine, A. F. Mah, and for the American-Canadian Thrombosis Study Group Low-Molecular-Weight Heparin vs Heparin in the Treatment of Patients With Pulmonary Embolism Arch Intern Med, January 24, 2000; 160(2): 229 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Cornuz, S. D. Pearson, and J. F. Polak Deep Venous Thrombosis: Complete Lower Extremity Venous US Evaluation in Patients without Known Risk Factors—Outcome Study Radiology, June 1, 1999; 211(3): 637 - 641. [Abstract] [Full Text]
|
|
|
|
 |
|
 G. Lippi, A. Mengoni, F. Manzato, and S. S. Anand Plasma D-Dimer in the Diagnosis of Deep Vein Thrombosis JAMA, December 2, 1998; 280(21): 1828 - 1829. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Kahn The Clinical Diagnosis of Deep Venous Thrombosis: Integrating Incidence, Risk Factors, and Symptoms and Signs Arch Intern Med, November 23, 1998; 158(21): 2315 - 2323. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Hull and G. F. Pineo Overview of Treatment of Venous Thromboembolism Based on Levels of Evidence Clinical and Applied Thrombosis/Hemostasis, October 1, 1997; 3(1_suppl): S68 - S71. [PDF]
|
|
|
|
|
|
J. Hirsh and J. Hoak Management of Deep Vein Thrombosis and Pulmonary Embolism : A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association Circulation, June 15, 1996; 93(12): 2212 - 2245. [Full Text]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, G. F. Pineo, and R. F. Brant The Low-Probability Lung Scan: A Need for Change in Nomenclature Arch Intern Med, September 25, 1995; 155(17): 1845 - 1851. [Abstract] [PDF]
|
|
|
|
|
|
R. J. Beyth, A. M. Cohen, and C. S. Landefeld Long-term Outcomes of Deep-Vein Thrombosis Arch Intern Med, May 22, 1995; 155(10): 1031 - 1037. [Abstract] [PDF]
|
|
|
|
 |
|
 E. E. Weinmann and E. W. Salzman Deep-Vein Thrombosis N. Engl. J. Med., December 15, 1994; 331(24): 1630 - 1641. [Full Text]
|
|
|
|
|
|
J. S. Ginsberg, P. S. Wells, J. Hirsh, A. A. Panju, M. A. Patel, D. E. Malone, J. McGinnis, P. Stevens, and P. Brill-Edwards Reevaluation of the Sensitivity of Impedance Plethysmography for the Detection of Proximal Deep Vein Thrombosis Arch Intern Med, September 12, 1994; 154(17): 1930 - 1933. [Abstract] [PDF]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, J. S. Ginsberg, A. A. Panju, P. Brill-Edwards, G. Coates, and G. F. Pineo A Noninvasive Strategy for the Treatment of Patients With Suspected Pulmonary Embolism Arch Intern Med, February 14, 1994; 154(3): 289 - 297. [Abstract] [PDF]
|
|
|
|
|
|
H. Heijboer, H. R. Buller, A. Lensing, A. Turpie, L. P. Colly, and J. W. ten Cate A Comparison of Real-Time Compression Ultrasonography with Impedance Plethysmography for the Diagnosis of Deep-Vein Thrombosis in Symptomatic Outpatients N. Engl. J. Med., November 4, 1993; 329(19): 1365 - 1369. [Abstract] [Full Text]
|
|
|
|
|
|
J. E. Dalen When Can Treatment Be Withheld in Patients With Suspected Pulmonary Embolism? Arch Intern Med, June 28, 1993; 153(12): 1415 - 1418. [Abstract] [PDF]
|
|
|
|
|
|
B. E. Hillner, J. T. Philbrick, and D. M. Becker Optimal Management of Suspected Lower-Extremity Deep Vein Thrombosis: An Evaluation With Cost Assessment of 24 Management Strategies Arch Intern Med, January 1, 1992; 152(1): 165 - 175. [Abstract] [PDF]
|
|
|
|
 |
|
 W. Seed Pulmonary embolism: Part 2 Diagnostic methods and management Vascular Medicine, September 1, 1991; 2(2): 121 - 136. [PDF]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, and C. J. Carter Serial Impedance Plethysmography in Pregnant Patients with Clinically Suspected Deep-Vein Thrombosis: Clinical Validity of Negative Findings Ann Intern Med, May 1, 1990; 112(9): 663 - 667. [Abstract] [PDF]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, G. Coates, A. A. Panju, and G. J. Gill A New Noninvasive Management Strategy for Patients With Suspected Pulmonary Embolism Arch Intern Med, November 1, 1989; 149(11): 2549 - 2555. [Abstract] [PDF]
|
|
|
|
|
|
H. B. WHEELER Ambulatory Management of Suspected Deep Vein Thrombosis Arch Intern Med, March 1, 1989; 149(3): 501 - 502. [Abstract] [PDF]
|
|
|
|
|
|
R. D. Hull, G. E. Raskob, C. J. Carter, G. Coates, G. J. Gill, D. L. Sackett, J. Hirsh, and M. Thompson Pulmonary Embolism in Outpatients With Pleuritic Chest Pain Arch Intern Med, April 1, 1988; 148(4): 838 - 844. [Abstract] [PDF]
|
|
|
|
|
|
J. R. Leclerc, R. M. Jay, R. D. Hull, and J. Hirsh Recurrent Leg Symptoms Following Deep Vein Thrombosis: A Diagnostic Challenge Arch Intern Med, October 1, 1985; 145(10): 1867 - 1869. [Abstract] [PDF]
|
|
|
|
|
|
R. D. HULL, J. HIRSH, C. J. CARTER, R. M. JAY, P. A. OCKELFORD, H. R. BULLER, A. G. TURPIE, P. POWERS, D. KINCH, P. E. DODD, et al. Diagnostic Efficacy of Impedance Plethysmography for Clinically Suspected Deep-Vein Thrombosis: A Randomized Trial Ann Intern Med, January 1, 1985; 102(1): 21 - 28. [Abstract] [PDF]
|
|
|
|
|
|
C. W. Francis, V. J. Marder, C. M. Evarts, and S. Yaukoolbodi Two-Step Warfarin Therapy: Prevention of Postoperative Venous Thrombosis Without Excessive Bleeding JAMA, January 21, 1983; 249(3): 374 - 378. [Abstract] [PDF]
|
|