Screening

Ultrasound screening

Compression ultrasound looking for evidence of acute DVT can be used as a 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.[130] Because less than half of patients who develop pulmonary embolism have ultrasound evidence of DVT in the legs, the value of detecting asymptomatic DVT in preventing pulmonary embolism is uncertain. Guidelines conflict regarding whether screening ultrasound should be performed in hospitalized trauma patients.[152] The American College of Chest Physicians suggests against such screening.[86]

Thrombophilia screening

Screening for thrombophilia in patients who have not yet had a DVT is not likely to be beneficial except in very rare circumstances (e.g., a known family history of antithrombin deficiency in a woman planning pregnancy).​[54][153]

Cancer screening

Routine screening for cancer, apart from assuring that all age-appropriate screening has been completed, is not currently recommended in patients with an unprovoked DVT.[139] Occult cancer is present in approximately 3% to 5% of patients with an unprovoked DVT.[138]​ However, extensive investigations (beyond routine laboratory tests and age-appropriate routine screening) for cancer in patients with a first unprovoked DVT are not routinely indicated, because they have not been convincingly shown to improve prognosis or mortality.[139][140]​​[141][142]​ Signs or symptoms that suggest a possible malignancy should be pursued, if present. Routine screening with computed tomography of the abdomen and pelvis did not provide a clinically significant benefit.[141]

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