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Research Letter
July 2015

Whole-Arm Ultrasound to Rule Out Suspected Upper-Extremity Deep Venous Thrombosis in Outpatients

Author Affiliations
  • 1Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
JAMA Intern Med. 2015;175(7):1226-1227. doi:10.1001/jamainternmed.2015.1683

Upper-extremity deep venous thrombosis (UE-DVT) accounts for approximately 14% of all cases of DVT.1 Because UE-DVT may provoke pulmonary embolism (PE), prompt diagnosis is necessary to select the patients who require anticoagulation. This study aimed to evaluate the failure rate of ultrasonographic screening for UE-DVT.

A prospective management study was conducted from January 1, 2011, through December 31, 2013, in the Angiology and Blood Coagulation Unit, University Hospital, Bologna, Italy, a tertiary care teaching hospital, in outpatients referred by general practice physicians to the vascular emergency department for suspected symptomatic DVT or superficial venous thrombosis (SVT) of the upper extremities. Exclusion criteria were age younger than 18 years, pregnancy or puerperium, PE symptoms, life expectancy of less than 3 months, and a need for anticoagulant therapy or anticoagulation lasting more than 48 hours. We enrolled eligible consecutive patients during business days. Patients with DVT or SVT received anticoagulants while patients with either negative or initially inconclusive findings from the ultrasonographic screening were not treated and were followed up for 3 months. The outcome was the cumulative 3-month incidence of objectively confirmed symptomatic PE and/or UE-DVT. All events were adjudicated by one of us (B.C.) who was not involved in patient enrollment or follow-up. Participants who were lost to follow-up were removed a priori from the analysis. This study was approved by the local Ethics Committee of Bologna University Hospital, Italy. Written informed consent was obtained for all patients.

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