Diagnosis of deep venous thrombosis of the lower limbs
Boccalon, H.
La Revue du Praticien 46(10): 1211-1217
1996
ISSN/ISBN: 0035-2640 PMID: 8763674 Document Number: 468505
The diagnosis of deep vein thrombosis (DVT) of lower limbs comprises three stages: clinical evocation, paraclinical confirmation, and etiologic detection. In a context with thrombogenic risk, a clinical sign evokes this diagnosis; nevertheless, it has to be confirmed as complications of DVT and risks of anticoagulation are essential. The realization of a test is compulsary; phlebography is the exam of reference which is not used anymore in routine; venous echo-Doppler is the most useful exam for the practitionner; the dosage of D-dimers excludes thrombosis if it is negative but its practice must be optimized. Clinical situations in which these tests are suggested are: a clinical suspicion of DVT, with a privileged place for echo-Doppler; a context of asymptomatic DVT which is the most difficult problem (only phlebography is validated in that case); the recurrence of thrombotic events where a previous exam of reference renders the detection of a recent trouble easier; pulmonary embolism where echo-doppler is looking for the presence of the source of a peripheral thrombus. The etiologic assessment has three levels: the analysis on the context and the risk factors of venous thrombosis; the realization of an hemostasis assessment and the dosage of physiologic inhibitors of coagulation in some suggestive clinical conditions; the research of an associated malignant disease.