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Contrast venography, in combination with symptomatic venous thromboembolism (VTE), is the standard efficacy outcome measure in clinical trials of thromboprophylaxis in major orthopedic surgery. It is uncertain whether performing bilateral venography offers any real advantage over venography of the operated leg alone. This study was undertaken to determine the risk of isolated contralateral deep vein thrombosis (DVT) following major orthopedic surgery and to evaluate whether bilateral venography, rather than venography on the operated leg alone, offers any gain in DVT detection and, thereby, improves efficiency in clinical study design. A systematic review of prospective studies that reported DVT incidence as the primary efficacy outcome based on mandatory bilateral venography in patients undergoing elective hip or knee arthroplasty or hip fracture repair was conducted. Based on the use of bilateral venography as a primary efficacy outcome measure, the incidence of any DVT is 16.7% following total hip replacement, 18.8% after hip fracture repair, and 33.8% after total knee replacement. While DVT risk in the operated leg varies depending on the type of surgery, the risk of isolated DVT in the non-operated leg is approximately 4% to 5% in all three procedures. By increasing the detection of any DVT, the use of bilateral venography reduces required sample size by 16% to 25% compared to ipsilateral venography. In clinical trials evaluating the efficacy of thromboprophylaxis in major orthopedic surgery, bilateral venography reduces the risk of undiagnosed DVT in the non-operated leg and improves the efficiency of study design by substantially reducing the sample size requirement.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

This review concluded that addition of computed tomography (CT) venography resulted in an increased detection rate of thromboembolic disease and CT venography combined with pulmonary CT angiography has a promising role as a quick and efficient test for venous thromboembolism. These conclusions may be not reliable given significant heterogeneity on the pooled outcome and limited methodological rigour of included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Evaluation of the accuracy of ultrasound has yielded heterogeneous results. Our objective was to summarize the evidence on the accuracy of ultrasound compared to venography in asymptomatic patients, taking into account the variation due to threshold differences. Searches of journal table of contents, computer databases (Medline, Embase, Biomed, Cochrane) and conference proceedings were performed. A study was eligible if it prospectively compared ultrasound to venography for the diagnosis of DVT in asymptomatic patients. Data of studies selected for inclusion were extracted independently by two authors. High quality studies with consecutive patient enrollment, blind evaluation of the two techniques, and absence of verification bias are summarized as Level 1, while those not fulfilling one or more of these criteria are considered Level 2. Original study authors were contacted to confirm accuracy and to provide missing data. A pooled estimate of the accuracy of ultrasound was obtained according to the method of Moses and coworkers. This method gives a summary diagnostic odds ratio (DOR). The DOR is a single indicator of test performance. It varies between 0 and infinity and exceeds 1, only when ultrasound is more often positive in patients with DVT relative to those without DVT. Higher DOR indicates better discriminatory test performance. Thirty one studies were rated as potentially unbiased and graded as Level 1. The mean prevalence of DVT as determined by venography was 22%. In Level 1 studies, the odds of positive ultrasound in proximal veins was 379 times higher (95% confidence limits 65, 2,200) and in distal veins 32 times higher (7.5, 135) among patients with DVT than those without. Our results suggest that, particularly for proximal veins, ultrasound is accurate for the diagnosis of DVT in asymptomatic postoperative orthopedic patients. More research is needed in other clinical settings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

About one in five adults have varicose veins. These bumpy, bluish veins are mostly a cosmetic issue for a lot of people. But they sometimes cause heavy-feeling legs, pain or muscle cramps. Read about the treatment options for varicose veins.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 13, 2016

This review concluded that magnetic resonance imaging has similar accuracy to ultrasound for the diagnosis of deep vein thrombosis. However, since the review did not assess ultrasound these conclusions are not supported by the results presented.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

This review assessed the relationship between the venographic evaluation of deep venous thrombosis and the incidence of recurrent venous thromboembolism in patients with deep vein thrombosis. The authors found an inverse correlation between venographically proven thrombus regression and recurrent venous thromboembolism. This review was generally well-conducted, but methodological weaknesses in the included studies suggest that the results should be interpreted cautiously.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

This generally well-conducted review concluded that methodological limitations, large between-study differences and small sample sizes limited the evidence on tests for diagnosing clinically suspected upper extremity deep vein thrombosis. These cautious conclusions reflect the limitations of the available evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The study found that the evidence on the relative effectiveness of thigh-length graduated compression stockings (GCSs) versus knee-length GCSs, in addition to pharmacological prophylaxis (heparin), for prevention of deep-vein thrombosis in surgical patients is weak and subject to considerable heterogeneity. Studies of patient adherence and preference found that patients favour knee-length stockings over thigh-length stockings. An analysis of all the available data using standard meta-analysis and network meta-analysis suggests that thigh-length stockings are more effective than knee-length stockings but that the benefit of GCSs over and above that achieved with heparin alone is small and may not be clinically significant. Further research could more precisely estimate the difference in treatment effect between knee-length and thigh-length stockings when used in combination with heparin, although the value and feasibility of a definitive trial is less clear. The value of further research is most evident in high-risk subgroups, and the effect of changes in patient characteristics and treatment patterns on DVT risk should be considered in any decision to undertake a trial.

Health Technology Assessment - NIHR Journals Library.

Version: November 2015

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein and then dislodges to travel in the blood (an embolus). A venous thrombus most commonly occurs in the deep veins of the legs or pelvis; this is then called a deep vein thrombosis (DVT). Blood flow through the affected vein can be limited by the clot, and it can cause swelling and pain in the leg. If it dislodges and travels to the lungs, to the pulmonary arteries, it is called a pulmonary embolism (PE), which in some cases may be fatal. VTE as a term includes both DVT and PE. Major risk factors for VTE include a prior history of DVT, age over 60 years, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility, thrombophilia (an abnormal tendency for the blood to clot) and pregnancy.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012

The objective of this report is to perform a systematic review of the beneficial and harmful effects of rivaroxaban 15 mg and 20 mg for the treatment of deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2015

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2012

This very large review assessed the clinical and cost-effectiveness of non-invasive testing options for the diagnosis of deep vein thrombosis. It concluded that diagnostic algorithms based on Wells score, D-dimer and ultrasound are likely to be the most feasible and cost-effective option for UK hospitals. These conclusions represent a reasonable interpretation of the data and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

The study found some evidence linking pelvic vein incompetence with chronic pelvic pain in women, but insufficient to conclude that it causes chronic pelvic pain in women suffering from no other pathology. Embolisation appears to be safe and to provide symptomatic relief for the majority of women.

Health Technology Assessment - NIHR Journals Library.

Version: January 2016

This guideline has been written within a conceptual framework which places the woman and her baby at the centre of care, appreciating that all postnatal care should be delivered in partnership with the woman and should be individualised to meet the needs of each mother-infant dyad. The guideline aims to identify the essential ‘core care’ which every woman and her baby should receive, as appropriate to their needs, during the first 6–8 weeks after birth, based upon the best evidence available.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: July 2006

There is no good evidence on the effects of thrombolysis for cerebral vein thrombosis. Blood drains from the brain into the cerebral veins and then into the cerebral venous sinuses. If a clot forms in one of these blood vessels, it can cause headaches, seizures, loss of consciousness and other neurological symptoms. Clot dissolving treatments (thrombolytic therapy) could help to clear the clot and improve the patients' condition. However, thrombolytic therapy can cause serious or even fatal bleeding in the brain. The reviewers did not find any reliable evidence from randomised trials about the balance of risk and benefit from this treatment. Randomised controlled trials of this treatment are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

Blood thinning (anticoagulant) drugs may be beneficial for patients with clotting of the veins that surround the brain (sinus thrombosis). Sinus thrombosis is a rare condition where blood clots form in the veins that drain blood from the brain. However, anticoagulant drugs, which are often used to treat sinus thrombosis, carry a risk of bleeding. We only found two small trials involving 79 patients; the results of the review suggested that anticoagulant drugs are probably safe and may be beneficial for people with sinus thrombosis but these results are not conclusive.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 10, 2011

A wide range of diagnostic tests may be useful in diagnosing deep vein thrombosis (DVT), including clinical assessment, D-dimer, plethysmography, rheography, ultrasound, computed tomographic (CT) scanning, magnetic resonance imaging (MRI) and venography. These may be used in isolation or combined as an algorithm.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2006

In response to a request from the public, an Evidence-based Practice Center funded by the Agency for Healthcare Research and Quality performed a review of the literature to evaluate the evidence regarding the relative accuracy of various imaging modalities for identifying and localizing the testicles in patients with cryptorchidism. Additionally, the comparative effectiveness and harms of various nonsurgical and surgical modalities for treating cryptorchidism were also assessed. This review did not cover studies of disorders of sexual development or ambiguous genitalia. The systematic review included 60 unique eligible studies published between 1980 and February 2012. An online version of this summary provides links directly to the sections of the full report with references for individual findings, inclusion criteria for the studies, and an explanation of the methods for rating the studies and determining the strength of evidence for individual findings. The online version of this summary and the full report are available at www.effectivehealthcare.ahrq.gov/undescended-testicle.cfm. This summary is provided to inform discussions with patients of options and to assist in decisionmaking along with consideration of a patient's or caregiver's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 30, 2013

Patients undergoing surgery of the large bowel and the rectum have a considerable risk of developing vascular complications expressed as venous thrombosis and/or thrombosis in the lungs (pulmonary embolism). These complications can lead to lifelong impaired venous function in the legs or occasionally sudden postoperative death. In order to avoid these complications, patients are often treated with blood‐thinning medicine (anticoagulation) and graded compression stockings during operation. A combination treatment of Heparin and TED‐stockings have been proved effective in general surgery. This review demonstrates that this combined treatment also is effective within the high‐risk group of patients undergoing surgery of the large bowel or rectum.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

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