notes (if applicable):
|Why this is important:- The Guideline Development Group noted that proximal leg vein ultrasound scans will not identify an isolated calf vein thrombus but that a repeat scan 1 week later will identify the clinically important thrombi that have extended. If a whole-leg scan is conducted initially, no repeat ultrasound at 1 week is required, but more patients may need anticoagulation therapy. More DVTs are identified by a whole-leg scan but this is more time-consuming and the impact on patient outcomes is unknown. Whole-leg scans are also more difficult technically and are subject to variability because there are more veins within the calf and they are considerably smaller; therefore there is still a risk of missing a calf vein thrombus. Repeating the proximal leg vein ultrasound scan after 1 week necessitates two scans, which is also time-consuming. A
randomised controlled trial (RCT) with cost-effectiveness analysis could answer the crucial
question of whether full-leg ultrasound improves patient outcomes and allow for more effective
use of NHS resources. Primary outcomes should include objectively confirmed 3-month
incidence of symptomatic venous thromboembolism (VTE) in patients with an initially normal
diagnostic work-up, mortality and major bleeding.