Screening

Ultrasound screening

Compression ultrasound looking for evidence of acute DVT is an excellent screening test in high-risk patients, such as patients who have sustained major trauma and patients who have recently undergone total hip or knee replacement. There is no convincing evidence, however, that screening reduces the incidence of adverse outcomes, particularly the incidence of fatal pulmonary embolism. The overall accuracy of screening ultrasound in asymptomatic patients is not clear but it is lower than in symptomatic patients.[100] Less than half of patients who develop pulmonary embolism have ultrasound evidence of DVT in the legs; therefore, the value of detecting asymptomatic DVT in preventing pulmonary embolism is uncertain. Guidelines conflict regarding whether screening ultrasound should be performed in hospitalised trauma patients.[101][102]

Thrombophilia screening

Consider testing for hereditary thrombophilia in patients who don't have an identifiable risk factor and have a first-degree relative who has had a VTE, if it is planned to stop anticoagulation.[12][26]

  • Do not routinely offer thrombophilia testing to first-degree relatives of people with a history of DVT and thrombophilia.[12]

  • Consider testing for antiphospholipid antibodies in patients who have had an unprovoked DVT if it is planned to stop anticoagulation treatment.[12][26] In practice, this is usually only done if the patient is young (aged <50 years). 

Be aware that tests for hereditary thrombophilia and antiphospholipid antibodies can be affected by anticoagulation; specialist advice may be needed.[12] 

Cancer screening

In any patient diagnosed with unprovoked DVT who is not known to have cancer:[12] 

  • Review medical history

  • Review baseline blood tests including full blood count, renal and hepatic function, prothrombin time (PT), and activated partial thromboplastin time (aPTT)

  • Offer a physical examination.[26]

Do not offer further investigations for cancer for patients with an unprovoked DVT unless they have relevant clinical symptoms or signs.[12] Occult cancer is present in approximately 3% to 5% of patients with an unprovoked DVT.[93] 

These recommendations are based on the National Institute for Health and Care Excellence in the UK. However, note that the European Society for Vascular Surgery recommends clinical examination and sex-specific cancer screening (but without routine extensive screening for cancer) if the patient has an unprovoked DVT.[26]

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