Diagnostic and therapeutic aspects of deep vein thrombosis

SI out-patients presenting with calf-vein thrombosis were randomized to treatment with hepann for five days or heparin with subsequent warfarin for three months. Among 23 patients in the warfarin-group no recurrence occured, whereas 8 of the 28 patients (29%) in the non-warfarin group had recurrent thrombo-embolism during the first 90 days. It is concluded that patients with symptomatic calf-vein thrombi should be treated with both heparin and oral anticoagulation. In a prospective study of X-ray contrast media, post-phlebographic reactions occurred in 7 of 19 patients (37%) investigated with a high-osmolality contrast medium metrizoate whereas no such reaction occured among 24 patients investigated with a low-osmolality contrast medium iohexol. Thus, low-osmolality contrast media should preferably be used at phlebography. 396 out-patients with suspected venous thrombosis were investigated with the ""Tc-plasmin test, physical examination and phlebography. The plasmin test has a high sensitivity (95%) but a low specificity (47%), and was frequently abnormal when clinical signs of inflammation were present. Clinical signs could not accurately predict if thrombosis was present, although subpopulations of patients with high or low probablity of venous thrombosis could be identified. 112 patients with suspected DVT were investigated with thermography. Both sensitivity and specificity were low (77% and 66% respectively) and thermography therefore seems not to be useful in the diagnosis of symptomatic venous thrombosis. Long-term sequelae after a first episode of venous thrombosis are mostly mild as long as 6 years after the diagnosis. Venous function correlated to the extension of the thrombus but not to subjective symptoms. Clinical signs at diagnosis could not predict the late outcome. During the six years of follow-up, 28% of the patients had recurrent thrombosis.