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Q J Med 2001; 94: 511-519
© 2001 Association of Physicians

Review

Screening for subclinical deep-vein thrombosis

J. Kelly, A. Rudd, R.R. Lewis and B.J. Hunt1

From the Elderly Care and 1 Haematology Departments, St Thomas' Hospital, London, UK


   Introduction
 
Most episodes of venous thromboembolism (VTE) are clinically silent; symptomatic events are merely the tip of the thromboembolism iceberg.1 The subgroup of events that evolve to develop clinical manifestations cannot accurately be predicted, and sudden death from pulmonary embolism (PE) may be the presenting feature. Consequently, various thromboprophylactic strategies are used to minimize the incidence of VTE in high-risk cohorts (Table 1Go). While all of these reduce the frequency of deep-vein thrombosis1 (DVT), a reduction in overall mortality has only been convincingly demonstrated with heparin.2


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  		Table 1 Prevalence of DVT in the absence of heparin prophylaxis in high-risk patient groups2,9,10

 
However, despite optimal prophylaxis, venographically-demonstrated DVTs still supervene in an important minority.1,3–6 Moreover, not all high-risk patients receive heparin, either because of contraindications, or because evidence of sustained benefit is lacking, as in acute ischaemic stroke.7 Given that the treatment of established VTE is highly effective,8 the concept of screening for . . . [Full Text of this Article]


   Prevalence of subclinical DVT
 

   Morbidity and mortality attributable to subclinical DVT
 

   Preventing adverse outcomes in patients with subclinical DVT
 

   Thromboprophylaxis in those at high risk of DVT
 
Heparin
Aspirin
Mechanical methods
Novel anti-thrombotics

   The rationale for screening
 

   Which patients should be considered for screening?
 

   How should patients be screened?
 
Contrast venography
Ultrasound
Fibrinogen uptake test
Impedance plethysmography
Magnetic resonance imaging
Plasma D-dimers

   Conclusion
 

   Notes
 

   References
 

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