Systematic review and meta-analysis of outcomes in patients with suspected deep vein thrombosis

Payal Patel, Parth Patel, Meha Bhatt, Cody Braun, Housne Begum, Robby Nieuwlaat, Rasha Khatib, Carolina C. Martins, Yuan Zhang, Itziar Etxeandia-Ikobaltzeta, Jamie Varghese, Hani Alturkmani, Waled Bahaj, Mariam Baig, Rohan Kehar, Ahmad Mustafa, Rakesh Ponnapureddy, Anchal Sethi, Merrill Thomas, David WooldridgeWendy Lim, Shannon M. Bates, Eddy Lang, Grégoire Le Gal, Marc Righini, Wojtek Wiercioch, Holger J. Schünemann, Reem A. Mustafa

Research output: Contribution to journalReview articlepeer-review

Abstract

After deep vein thrombosis (DVT) is diagnosed, prompt evaluation and therapeutic intervention are of paramount importance for improvement in patient-important outcomes. We systematically reviewed patient-important outcomes in patients with suspected DVT, including mortality, incidence of pulmonary embolism (PE) and DVT, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, Ovid Medline, Embase for eligible studies, references lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Nine studies with 5126 patients were included for lower extremity DVT. Three studies with 500 patients were included for upper extremity DVT. Among patients with lower extremity DVT, 0.85% (95% confidence interval [CI], 0% to 2.10%) and 0% developed recurrent DVT and PE, respectively, at 3 months. Among patients with upper extremity DVT, 0.49% (95% CI, 0% to 1.16%) and 1.98% (95% CI, 0.62% to 3.33%) developed recurrent DVT and PE, respectively, at 3 months. No major bleeding events were reported for those anticoagulated, which is lower than in other systematic reviews. For both upper and lower extremity DVT, low pretest probability patients with a negative D-dimer had a comparable incidence of VTE at 3 months (∼1%) as patients with a negative ultrasound (US). At higher pretest probabilities, negative US testing with or without serial US appears to be the safer option. In this review, we summarized the outcomes of patients evaluated by various diagnostic pathways. In most instances, there was significant limitation due to small population size or lack of direct evidence of effects of using a specific pathway. This systematic review was registered at PROSPERO as CRD42018100502.

Original languageEnglish
Pages (from-to)2779-2788
Number of pages10
JournalBlood Advances
Volume4
Issue number12
DOIs
StatePublished - Jun 23 2020

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