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Ultrasonic testing ruled out blood clots in pregnant women
Serial compression ultrasonography with Doppler imaging ruled out deep vein thrombosis in symptomatic pregnant women, according to results of a prospective cohort study.
Compression ultrasonography performed in sequence over a 7-day period is recommended for the diagnosis of deep vein thrombosis (DVT) in symptomatic pregnant women. Whether the approach is safe for this patient population remains unclear, according to background information provided by researchers.
Wee-Shian Chan
Wee-Shian Chan, MSc, MD, FRCP, assistant professor in the department of medicine at BC Women’s Hospital and Health Center in Vancouver, British Columbia, and colleagues evaluated the diagnostic accuracy and safety of withholding anticoagulation from pregnant women with possible DVT following negative serial compression ultrasonography and Doppler imaging of the iliac vein.
Researchers enrolled 221 pregnant women presenting with suspected DVT at four Canadian centers from August 2002 to September 2010.
Researchers diagnosed 16 pregnant women (7.2%) in the cohort with objectively confirmed DVT. Of them, 94% were detected at presentation by compression ultrasonography with Doppler imaging of the iliac vein. Those patients underwent treatment with anticoagulants.
Researchers followed up with 205 patients whose serial tests did not detect DVT for a minimum of 3 months after treatment delivery. Six later presented with symptoms of DVT or pulmonary embolism (PE), and one patient was diagnosed as having DVT and PE.
The proportion of DVT during follow-up was 0.49% (95% CI, 0.09%-2.71%), and the sensitivity of serial compression ultrasonography with Doppler imaging was 94.1%, study results showed.
The findings suggest it is likely safe for physicians to withhold anticoagulation in women with negative imaging results.
“Our strategy of serial compression ultrasonography combined with Doppler imaging of the iliac veins appears to reliably exclude clinically important DVT,” Chan and colleagues wrote.
Because all cases of DVT were identified by initial imaging with compression ultrasonography and Doppler studies, it is unclear whether serial testing over a 7-day period is necessary, the researchers added.
Disclosure: Chan reports no relevant financial disclosures. Other researchers report advisory board and consulting roles with, as well as lecture, grant and travel fees from, Bayer, Boehringer Ingelheim, Pfizer and other pharmaceutical companies.