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How to utilize a new pre-test probability score for diagnosis of deep vein thrombosis before surgery?

Published:August 09, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.07.011

      Keywords

      To the editor:
      Venous thromboembolism, dominantly from deep vein thrombosis (DVT), is a serious perioperative complication that is associated with mortality and morbidity [
      • Nakamura M.
      • Yamada N.
      • Ito M.
      Current management of venous thromboembolism in Japan: current epidemiology and advances in anticoagulant therapy.
      ]. We congratulate Hamamoto and colleagues, who developed a novel pre-test probability score to predict the incidence of DVT prior to major surgery [
      • Hamamoto Y.
      • Tokushige A.
      • Toshinori Y.
      • Ikeda Y.
      • Horizoe Y.
      • Yasuda H.
      • et al.
      A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery.
      ]. Several concerns have been raised.
      In this study, all participants had D-dimer ≥1.0 μg/mL2, which might be a potential selection bias. Applicability of their novel score to those with D-dimer <1.0 μg/mL might remain uncertain.
      The authors used cut-offs of each item by referencing the previous studies or the upper limits of normal reference values [
      • Hamamoto Y.
      • Tokushige A.
      • Toshinori Y.
      • Ikeda Y.
      • Horizoe Y.
      • Yasuda H.
      • et al.
      A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery.
      ]. Cut-offs that are statistically calculated for the prediction of clinical outcomes might give us greater predictability.
      Approximately 25 % of the patients were excluded from their study, including those with intra-vascular devices, ongoing anti-coagulants, and aneurysm [
      • Hamamoto Y.
      • Tokushige A.
      • Toshinori Y.
      • Ikeda Y.
      • Horizoe Y.
      • Yasuda H.
      • et al.
      A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery.
      ]. We understand the reason for their exclusion: their considerable impacts on the D-dimer levels. Nevertheless, these patients should be the cohort in which we struggle to survey DVT in daily practice. Could the authors suggest to the readers any strategies to detect DVT among such a challenging cohort?
      We would like to ask the authors further strategy following the calculation of their novel score. The incidence of DVT in patients who were assigned to the low risk was 6–7 % [
      • Hamamoto Y.
      • Tokushige A.
      • Toshinori Y.
      • Ikeda Y.
      • Horizoe Y.
      • Yasuda H.
      • et al.
      A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery.
      ]. Could we ignore the estimated incidence of DVT, although not so high, and exempt those with low risk from receiving whole-leg ultrasonography?

      Declaration of competing interest

      None.

      References

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        • Yamada N.
        • Ito M.
        Current management of venous thromboembolism in Japan: current epidemiology and advances in anticoagulant therapy.
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        • Hamamoto Y.
        • Tokushige A.
        • Toshinori Y.
        • Ikeda Y.
        • Horizoe Y.
        • Yasuda H.
        • et al.
        A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery.
        J Cardiol. 2022; 79: 664-670