Single ultrasonography scan could rule out pregnancy-related DVT
MedWire News: A single complete compression ultrasonography result may "safely" exclude the diagnosis of deep vein thrombosis (DVT) in pregnant and postpartum women, a study shows.
The risk for DVT increases during pregnancy, explained Gregoire Le Gal (Centre Hospitalier Universitaire de la Cavale Blanche, Brest, France) in a press statement. However, accurately diagnosing it is challenging, and tests that are safe in nonpregnant patients are not always appropriate for pregnant patients.
In recent years, realtime compression ultrasonography has become the most common diagnostic test for DVT, but it has not been evaluated prospectively in pregnant and postpartum women.
Le Gal and colleagues therefore assessed the outcomes of 210 pregnant and postpartum (until 3 months after giving birth) women who underwent a single proximal and distal compression ultrasonography for the detection of DVT.
DVT was ruled out in women with a negative compression ultrasonography test result and no visualized thrombus. These women did not receive anticoagulant therapy and were followed up for 3 months.
DVT was diagnosed if there was lack of compressibility of a deep vein, and in absence of Doppler flow or direct visualization of a thrombus for the iliac vein.
DVT was detected in 22 (10.5%) women. The proportion of women with DVT according to stage of pregnancy was 18.2% during the first trimester, 4.5% during the second, 40.9% during the third, and 36.4% during the postpartum period.
Ten patients received full-dose anticoagulation despite a negative test result during follow up.
Of the 177 patients who were not diagnosed with DVT and did not receive full-dose anticoagulant therapy, two (1.1%) had an objectively confirmed DVT during follow up.
"This result is in line with what was reported after a normal phleobography - the reference test - in nonpregnant patients," comment the authors.
They add: "Our study shows that single complete compression ultrasonography might safely rule out the diagnosis of DVT in pregnant and postpartum women."
"Further investigations should aim at confirming these results and evaluating the use of compression ultrasonography in a sequential diagnostic strategy including assessment of clinical probability and D-dimer measurement," Le Gal and team conclude.
By Piriya Mahendra