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Meta-Analysis
. 2020 Jun 9;4(11):2516-2522.
doi: 10.1182/bloodadvances.2019001409.

Diagnosis of deep vein thrombosis of the upper extremity: a systematic review and meta-analysis of test accuracy

Payal Patel  1 , Cody Braun  2 , Parth Patel  3 , Meha Bhatt  4 , Housne Begum  4 , Wojtek Wiercioch  4 , Jamie Varghese  3 , David Wooldridge  3 , Hani J Alturkmani  3 , Merrill Thomas  3 , Mariam Baig  3 , Waled Bahaj  3 , Rasha Khatib  5 , Rohan Kehar  6 , Rakesh Ponnapureddy  3 , Anchal Sethi  3 , Ahmad Mustafa  3 , Wendy Lim  7   8 , Grégoire Le Gal  9 , Shannon M Bates  7   10 , Eddy Lang  11 , Marc Righini  12 , Nedaa M Husainat  13 , Mohamad A Kalot  13 , Yazan Nayif Al Jabiri  14 , Robby Nieuwlaat  4 , Holger J Schünemann  4   7 , Reem A Mustafa  4   13
Affiliations
Meta-Analysis

Diagnosis of deep vein thrombosis of the upper extremity: a systematic review and meta-analysis of test accuracy

Payal Patel et al. Blood Adv. .

Abstract

Upper extremity deep vein thrombosis (UEDVT) accounts for ≤10% of DVT and can be associated with morbidity and mortality. Accurate diagnosis and treatment are necessary for safe and effective patient management. We systematically reviewed the accuracy of D-dimer and duplex ultrasonography (US) for the evaluation of suspected first-episode UEDVT. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and PubMed for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included prospective cross-sectional and cohort studies that evaluated test accuracy. Two investigators independently screened and collected data. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 9 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.96 (95% confidence interval [CI], 0.87-0.99) and 0.47 (95% CI, 0.43-0.52), respectively. The pooled estimates for duplex US sensitivity and specificity were 0.87 (95% CI, 0.73-0.94) and 0.85 (95% CI, 0.72-0.93), respectively. Certainty of evidence was moderate. In this review, we summarized the test accuracy (sensitivity and specificity) of D-dimer and duplex US for this indication. The sensitivity and specificity of the tests found in the present review should be considered in the context of whether they are used alone or in combination, which is dependent on the prevalence of disease in the population, the clinical setting in which the patient is being evaluated, cost, potential harms, and patient outcomes. This study was registered at PROSPERO as Systematic Review Registration Number CRD42018098488.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for study selection.
Figure 2.
Figure 2.
Pooled sensitivity and specificity of D-dimer for diagnosis of UEDVT.
Figure 3.
Figure 3.
Pooled sensitivity and specificity of duplex US for diagnosis of UEDVT. FN, false negative; FP, false positive; TN, true negative; TP, true positive.
See this image and copyright information in PMC

References

    1. Baarslag HJ, van Beek EJ, Koopman MM, Reekers JA. Prospective study of color duplex US compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities [published correction appears in Ann Intern Med. 2003;138(5):438]. Ann Intern Med. 2002;136(12):865-872. - PubMed
    1. Baxter GM, Kincaid W, Jeffrey RF, Millar GM, Porteous C, Morley P. Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol. 1991;64(765):777-781. - PubMed
    1. Kröger K, et al. . Colour Doppler sonographic diagnosis of upper limb venous thromboses. Clin Sci. 1998;94:657-661. - PubMed
    1. Kommareddy A, Zaroukian MH, Hassouna HI. Upper extremity deep venous thrombosis. Semin Thromb Hemost. 2002;28(1):89-99. - PubMed
    1. Rooden CJ, Tesselaar MET, Osanto S, Rosendaal FR, Huisman MV. Deep vein thrombosis associated with central venous catheters: a review. J Thromb Haemost. 2005;3(11):2409-2419. - PubMed

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