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Meta-analysis: Withholding anticoagulants after negative ultrasound led to low risk for VTE

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Withholding anticoagulation therapy in patients with suspected deep vein thrombosis after a negative whole-leg compression ultrasound was associated with a low risk for developing a venous thromboembolism at three-month follow-up, according to the results of a meta-analysis.

Researchers pooled data from randomized controlled trials and prospective cohort studies that examined the risk of VTE in patients with suspected lower-extremity deep vein thrombosis after a single negative whole-leg compression ultrasound results for whom anticoagulation was withheld. Articles were published from January 1970 to November 2009.

The review and meta-analysis consisted of seven studies that included 4,731 patients. Of these patients, 15.3% had recently undergone surgery; 13.7% had active cancer.

The overall VTE event rate at three months was 0.57% (95% CI, 0.25%-0.89%). Death associated with VTE or suspected association of VTE occurred in 34 patients (0.7%). Eleven patients (32.4%) had distal deep vein thrombosis, seven (20.6%) had proximal deep vein thrombosis and seven (20.6%) had nonfatal pulmonary emboli.

In an accompanying editorial, Robert A. McNutt, MD, PhD, of Rush University Medical Center, Chicago, and Edward H. Livingston, MD, of the University of Texas Southwestern Medical Center, Dallas, wrote, “Greater detail about individual patient scenarios is necessary to facilitate better application of the study results to individual patients. One helpful approach may be for reports of meta-analyses to include, in detail, the inclusion and exclusion criteria for patients enrolled in the original studies.

“However, summary statements from meta-analyses should not be used to guide patient care. Such conclusions are not helpful when the clinical studies are combined and averaged in a way that reduces the complex world of medical care to overly simple and consequently not clinically useful statistical summaries,” they wrote.

Johnson SA.JAMA. 2010;303:438-445.

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