Baseline Imaging After Therapy for Unprovoked Venous Thromboembolism: A Randomised Controlled Comparison of Baseline Imaging for Diagnosis of Suspected Recurrence.
J Thromb Haemost. 2011 Oct 11;
Authors: Hamadah A, Alwasaidi T, Le Gal G, Carrier M, Wells PS, Scarvelis D, Gonsalves C, Forgie M, Kovacs MJ, Rodger MA
Abstract
Background:?After a first unprovoked venous thromboembolism (VTE) many patients have residual pulmonary and/or lower limb vascular obstruction following completion of short term anticoagulation. Residual vascular obstruction may complicate the diagnosis of recurrent VTE. Whether baseline imaging, conducted after completion of anticoagulation, helps in interpreting diagnostic testing in patients who subsequently have suspected recurrent VTE is unknown. Study design:?The REVERSE study is a cohort study whose primary aim was to derive a clinical decision rule to guide duration of anticoagulation after a first unprovoked VTE. All patients underwent baseline imaging after completing 5-7 months of anticoagulant therapy. We performed a post-hoc randomized controlled comparison among 121 patients investigated for a suspected recurrent VTE during follow-up: decision on recurrent VTE with or without baseline imaging made available to two independent adjudicators. Results:?The proportion of patients not classifiable for recurrent VTE was statistically significantly higher in the group with no baseline imaging than in the group with baseline imaging: one in five as compared with one in 25. The inter-observer agreement between the two adjudicators was better in the group with baseline imaging than in the group with no baseline imaging: kappa values 0.78 and 0.54, respectively. Conclusion:?In patients with a first unprovoked VTE, baseline imaging at completion of anticoagulant therapy helps in interpreting diagnostic tests performed in case of suspected recurrent VTE.
PMID: 21985174 [PubMed - as supplied by publisher]