Diagnostic Algorithm in Suspected Upper Extremity Deep Vein Thrombosis

Consecutive patients with clinically suspected upper extremity deep vein thrombosis (UEDVT) are potentially eligible for the study. Patients will be categorized as likely or unlikely to have UEDVT based on a clinical decision rule (CDR). Patients "unlikely" for UEDVT based on the CDR and with normal D-dimer levels will not receive anticoagulant treatment and will be followed-up for 3 months. All patients with a likely CDR or patients with an unlikely CDR combined with elevated D-dimer levels will undergo ultrasonography. In case of an indeterminate ultrasonography result, ultrasonography testing will be repeated 3-5 days later. The same applies for patients with a negative ultrasound and the combination of a high probability and elevated D-dimer levels. Anticoagulants will be withheld in all patients for whom UEDVT will be excluded by the initial diagnostic work-up.

Inclusion criteria

• Patients from the emergency department, in and out patient clinic with clinically suspected upper extremity deep vein thrombosis

Exclusion criteria

• No informed consent obtained
• Legal age limitation (country specific)
• Use of anticoagulants in therapeutic dosages longer than 24 hours prior to randomisation
• Prior vein thrombosis in the same arm
• Life expectancy < 3 months
• Haemodynamic instability
• Previous participation in the study