Recommendation ID
CG144/1
Question
Diagnosis of deep vein thrombosis:- What is the clinical and cost effectiveness of a whole-leg ultrasound scan compared with a proximal leg vein ultrasound scan in the diagnosis of acute deep vein thrombosis (DVT)?
Any explanatory 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.

Source guidance details

Comes from guidance
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Number
CG144
Date issued
June 2012

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 10/07/2012