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Type:	Artigo de Periódico
Title:	Systematic review and meta-analysis of outcomes in patients with suspected deep vein thrombosis
Authors:	Payal Patel Parth Patel Meha Bhatt Cody Braun Housne Begum Robby Nieuwlaat Rohan Kehar Rasha Khatib Carolina de Castro Martins Yuan Zhang Itziar Etxeandia-Ikobaltzeta Jamie Varghese Hani Alturkmani Waled Bahaj Mariam Baig Rohan Kehar Ahmad Mustafa Rakesh Ponnapureddy Anchal Sethi Merrill Thomas David Wooldridge Wendy Lim Shannon Bates Eddy Lang Gregoire Le Gal Marc Righini Wojtek Wiercioch Holger Schunemann Reem Mustafa
Abstract:	After deep vein thrombosis (DVT) is diagnosed, prompt evaluation and therapeutic intervention are of paramount importance for improvement in patient-important outcomes. We systematically reviewed patient-important outcomes in patients with suspected DVT, including mortality, incidence of pulmonary embolism (PE) and DVT, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, Ovid Medline, Embase for eligible studies, references lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Nine studies with 5126 patients were included for lower extremity DVT. Three studies with 500 patients were included for upper extremity DVT. Among patients with lower extremity DVT, 0.85% (95% confidence interval [CI], 0% to 2.10%) and 0% developed recurrent DVT and PE, respectively, at 3 months. Among patients with upper extremity DVT, 0.49% (95% CI, 0% to 1.16%) and 1.98% (95% CI, 0.62% to 3.33%) developed recurrent DVT and PE, respectively, at 3 months. No major bleeding events were reported for those anticoagulated, which is lower than in other systematic reviews. For both upper and lower extremity DVT, low pretest probability patients with a negative D-dimer had a comparable incidence of VTE at 3 months (∼1%) as patients with a negative ultrasound (US). At higher pretest probabilities, negative US testing with or without serial US appears to be the safer option. In this review, we summarized the outcomes of patients evaluated by various diagnostic pathways. In most instances, there was significant limitation due to small population size or lack of direct evidence of effects of using a specific pathway. This systematic review was registered at PROSPERO as CRD42018100502.
Subject:	Health services Outcome and process assessment, health care Thrombosis Hemostasis
language:	eng
metadata.dc.publisher.country:	Brasil
Publisher:	Universidade Federal de Minas Gerais
Publisher Initials:	UFMG
metadata.dc.publisher.department:	FAO - DEPARTAMENTO DE ODONTOPEDIATRIA E ORTODONTIA
Rights:	Acesso Restrito
metadata.dc.identifier.doi:	https://doi.org/10.1182/bloodadvances.2020001558
URI:	http://hdl.handle.net/1843/67730
Issue Date:	Jun-2020
metadata.dc.url.externa:	https://ashpublications.org/bloodadvances/article/4/12/2779/461054/Systematic-review-and-meta-analysis-of-outcomes-in
metadata.dc.relation.ispartof:	Blood Advances
Appears in Collections:	Artigo de Periódico

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