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Thromb Haemost 1993; 69(01): 002-007
DOI: 10.1055/s-0038-1651177
Original Article
Clinical Studies
Schattauer GmbH Stuttgart

125I-Fibrinogen Leg Scanning: Reassessment of Its Role for the Diagnosis of Venous Thrombosis in Post-Operative Patients

Anthonie W A Lensing
The Hamilton Civic Hospital Research Centre, Hamilton, Ontario, Canada
,
Jack Hirsh
The Hamilton Civic Hospital Research Centre, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Received 29 March 1992

Accepted after revision 21 August 1992

Publication Date:
04 July 2018 (online)

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Summary

Objective: To determine the reasons why 125I-fibrinogen leg scanning, a screening test which was reported to be very sensitive for the detection of post-operative thrombosis, has shown poor sensitivity in contemporary studies.

Study Identification: English-language reports were identified through a Medline computer search (1965-1991), Current Contents, and an extensive manual search of the bibliographies in identified articles.

Study Selection: Studies in orthopaedic or general surgical patients were reviewed that compared 125I-fibrinogen leg scanning with venography in all patients (accuracy studies) or in patients in whom 125I-fibrinogen leg scanning became positive (positive predictive value studies).

Data Extraction: A systematic appraisal of study design and specific descriptive information concerning the selection of patients.

Results of Data Synthesis: Six of the 15 studies which compared 125I-fibrinogen leg scanning with venography were level 1 studies (potential for bias minimized) and nine were classified as level 2 studies (potential for bias not minimized). In orthopaedic surgical patients, the pooled sensitivity of leg scanning for isolated calf vein thrombosis, for all venous thrombosis, and the pooled specificity were 55%, 45%, and 92% for the level 1 studies, respectively. These indices were 88%, 82%, and 79%, respectively for the level 2 studies (P <0.001). Only two (level 2) studies were found that evaluated the accuracy of leg scanning for venous thrombosis in general surgical patients.

Conclusion: We conclude that leg scanning is an insensitive method for the screening of post-operative venous thrombosis in orthopaedic patients. Our findings call into question the validity of the many studies (including meta-analyses) evaluating prophylactic agents for venous thrombosis which used leg scanning as the only test for the assessment of efficacy.

 

  • References

  • 1 Atkins P, Hawkins LA. Detection of venous thrombosis in the legs. Lancet 1965; 1: 1217-1219
    PubMedGoogle Scholar
  • 2 Nanson EM, Palko PD, Dick AA. et al. Early detection of deep vein thrombosis of the leg using 131-tagged human fibrinogen: a clinical study. Ann Surg 1965; 162: 438-445
    CrossrefPubMedGoogle Scholar
  • 3 Flanc C, Kakkar VV, Clarke MB. Detection of venous thrombosis of the legs using 125I-labelled fibrinogen. Br J Surg 1968; 55: 742-747
    CrossrefPubMedGoogle Scholar
  • 4 Kakkar VV. The diagnosis of deep vein thrombosis using the 125I-fibrinogen test. Arch Surg 1972; 104: 152-159
    CrossrefPubMedGoogle Scholar
  • 5 Kakkar VV. Deep vein thrombosis. Detection and prevention. Circulation 1975; 51: 8-19
    CrossrefPubMedGoogle Scholar
  • 6 Kakkar VV. Fibrinogen uptake test for detection of deep vein thrombosis – A review of current practice. Semin Nucl Med 1977; 7: 229-244
    CrossrefPubMedGoogle Scholar
  • 7 Lambie JM, Mahaffy RG, Barber DC, Karmody AM, Scott MM, Matheson NA. Diagnostic accuracy in venous thrombosis. Br Med J 1970; 2: 142-143
    CrossrefPubMedGoogle Scholar
  • 8 Tsapogas MJ, Goussus H, Peabody RA, Karmody AM, Eckert C. Postoperative venous thrombosis and the effectiveness of prophylactic measures. Arch Surg 1971; 103: 561-567
    CrossrefPubMedGoogle Scholar
  • 9 Field ES, Nicolaides AN, Kakkar VV, Crellin RQ. Deep vein thrombosis in patients with fractures of the femoral neck. Br J Surg 1972; 59: 377-379
    CrossrefPubMedGoogle Scholar
  • 10 Myrvold HE, Persson JE, Svensson B, Wallensten S, Vikterlof KJ. Prevention of thromboembolism with Dextran 70 and heparin in patients with femoral neck fractures. Acta Chir Scand 1973; 139: 609-616
    PubMedGoogle Scholar
  • 11 Flicoteaux H, Kher A, Jean N, Blery M, Judet T, Honnart F, Pasteyer J. Comparison of low dose heparin and low dose heparin combined with aspirin in prevention of deep vein thrombosis after total hip replacement. Pathol Biol 1977; 25: 55-58
    PubMedGoogle Scholar
  • 12 Roberts VC. Fibrinogen uptake scanning for diagnosis of deep vein thrombosis: a plea for standardization. Br Med J 1975; 3: 455-458
    CrossrefPubMedGoogle Scholar
  • 13 Harris WH, Athanasoulis C, Waltman AC, Salzman EW. Cuff-impedance phlebography and 125I fibrinogen scanning versus roentgenographic phlebography for diagnosis of thrombophlebitis following hip surgery. J Bone Joint Surg 1976; 58: 939-944
    CrossrefPubMedGoogle Scholar
  • 14 Sautter RD, Larson DE, Bhattacharyya SK, Chen HM, Treuhaft PS, Milbauer JP. et al. The limited utility of fibrinogen 125I leg scanning. Arch Intern Med 1979; 139: 148-153
    CrossrefPubMedGoogle Scholar
  • 15 Sautter RD, Koch EL, Myers WO, Ray JR, Mazza JJ, Larson DE. et al. Aspirin-sulfinpyrazone in prophylaxis of deep venous thrombosis in total hip replacement. JAMA 1983; 250: 2649-2654
    CrossrefPubMedGoogle Scholar
  • 16 Faunø P, Suomalainen O, Bergqvist D, Fredin H, Kettunen K, Soimakallio S. The use of the firbinogen uptake test in screening for deep vein thrombosis in patients with hip fracture. Thromb Res 1990; 60: 185-190
    CrossrefPubMedGoogle Scholar
  • 17 Paiement G, Wessinger SJ, Waltmann AC, Harris WH. Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Am J Surg 1988; 155: 400-404
    CrossrefPubMedGoogle Scholar
  • 18 Cruickshank MK, Levine MN, Hirsh J, Turpie AG G, Powers P, Jay R, Gent M. An evaluation of impedance plethysmography and 125I-fibrinogen leg scanning in patients following hip surgery. Thromb Haemostas 1989; 62: 830-834
    PubMedGoogle Scholar
  • 19 Hull RD, Raskob GE, Gent M. et al. Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement. JAMA 1990; 263: 2313-2317
    CrossrefPubMedGoogle Scholar
  • 20 Sackett DL, Haynes RB, Tugwell P. The interpretation of diagnostic data. In: Clinical Epidemiology. A Basic Science for Clinical Medicine. Little, Brown and Company; Boston/Toronto: 1985
    Google Scholar
  • 21 Loudon JR, McGarrity G, Vallance R, Baylis AC, Graham J. The fibrinogen uptake test after hip surgery. Br J Surg 1978; 65: 616-618
    CrossrefPubMedGoogle Scholar
  • 22 Moskovitz PA, Ellenberg SS, Feffer HL, Kenmore PI, Neviaser RJ, Rubin BE, Varma VM. Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures. J Bone Joint Surg 1978; 60: 1065-1070
    CrossrefPubMedGoogle Scholar
  • 23 Suomalainen O, Kettunen K, Rissanen V, Lansimies E, Tanska S. The 125I-labelled fibrinogen uptake test in elective hip surgery. Ann Clin Res 1985; 17: 24-26
    PubMedGoogle Scholar
  • 24 Comerota AJ, Katz ML, Grossi RJ, White JV, Czeredarczuk M, Bowman G. The comparative value of noninvasive testing for diagnosis and surveillance of deep vein thrombosis. J Vase Surg 1988; 7: 40-49
    CrossrefPubMedGoogle Scholar
  • 25 Hull R, Hirsh J, Sackett DL, Powers P, Turpie AG, Walker I, McBride J. The value of adding impedance plethysmography to 125I-fibrinogen leg scanning for the detection of deep vein thrombosis in high risk surgical patients: a comparative study between patients undergoing general and hip surgery. Thromb Res 1979; 15: 227-234
    CrossrefPubMedGoogle Scholar
  • 26 Mátzsch T, Bergqvist D, Fredin H, Hedner U. Low molecular weight heparin compared with dextran as prophylaxis against thrombosis after total hip replacement. Acta Chir Scand 1990; 156: 445-450
    PubMedGoogle Scholar
  • 27 Pinto DJ. Controlled trial of an anticoagulant in the prevention of venous thrombosis following hip surgery. Br J Surg 1970; 57: 349-352
    CrossrefPubMedGoogle Scholar
  • 28 Halpin DS, Jefferiss CD, Ling RS, Hume M, Gurewich V, Negus D, Evans DS. Peripheral venous scanning with 125I-tagged fibrinogen. Lancet 1972; 1: 845-846
    PubMedGoogle Scholar
  • 29 Xabregas A, Gray L, Ham JM. Heparin prophylaxis of deep vein thrombosis in patients with a fractured neck of the femur. Med J Aust 1978; 1: 620-622
    PubMedGoogle Scholar
  • 30 Fredin HO, Nillius SA, Bergqvist D. Prophylaxis of deep vein thrombosis in patients with fracture of the femoral neck. Acta Orthop Scand 1982; 53: 413-417
    CrossrefPubMedGoogle Scholar
  • 31 Alfaro MJ, Paramo JA, Rocha E. Prophylaxis of thromboembolic disease and platelet related changes following total hip replacement: a comparative study of aspirin and heparin-dihydroergoamine. Thromb Haemostas 1986; 56: 53-56
    PubMedGoogle Scholar
  • 32 Eriksson BI, Zachrisson BE, Teger-Nilsson AC, Risberg B. Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br J Surg 1988; 75: 1053-1057
    CrossrefPubMedGoogle Scholar
  • 33 Pini M, Tagliaferri A, Manotti C, Lasagni F, Rinaldi E, Dettori AG. Low molecular weight heparin compared with unfractionated heparin in prevention of deep vein thrombosis after hip fractures. Int Angiol 1989; 8: 134-139
    PubMedGoogle Scholar
  • 34 Ockelford PA, Patterson J, Johns AS. A double-blind randomized placebo controlled trial of thromboprophylaxis in major elective general surgery using once daily injections of a low molecular weight heparin fragment. Thromb Haemostas 1987; 62: 1046-1050
    PubMedGoogle Scholar
  • 35 Negus D, Pinto DJ, Le Quesne LP, Brown N, Chapman M. 125I-labelled fibrinogen in the diagnosis of deep vein thrombosis and its correlation with phlebography. Br J Surg 1968; 55: 835-839
    CrossrefPubMedGoogle Scholar
  • 36 Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep vein thrombosis. Lancet 1969; 2: 230-232
    PubMedGoogle Scholar
  • 37 Milne RM, Gunn AA, Griffiths JMT, Ruckley CXV. Postoperative deep venous thrombosis. A comparison of diagnostic techniques. Lancet 1971; 2: 445-447
    PubMedGoogle Scholar
  • 38 Bonnar J, Walsh J. Prevention of thrombosis after pelvic surgery by British dextran 70. Lancet 1972; 1: 614-616
    PubMedGoogle Scholar
  • 39 Gallus AS, Hirsh J, Tuttle RJ. et al. Small subcutaneous doses of heparin in prevention of venous thrombosis. N Engl J Med 1973; 288: 545-551
    CrossrefPubMedGoogle Scholar
  • 40 Becker J, Schampi B. The incidence of postoperative venous thrombosis of the legs. Acta Chir Scand 1973; 139: 357-367
    PubMedGoogle Scholar
  • 41 Abernethy EA, Hartsuck JM. Postoperative pulmonary embolism. Am J Surg 1974; 128: 739-742
    CrossrefPubMedGoogle Scholar
  • 42 Covey TH, Sherman L, Baue AE. Low dose heparin in postoperative patients. Arch Surg 1975; 110: 1021-1026
    CrossrefPubMedGoogle Scholar
  • 43 Gallus AS, Hirsh J, O’Brien SE, McBride JA, Tuttle RJ, Gent M. Prevention of venous thrombosis with small, subcutaneous doses of heparin. JAMA 1976; 235: 1980-1982
    CrossrefPubMedGoogle Scholar
  • 44 Wu TK, Tsapogas MJ, Jordan FR. Prophylaxis of deep venous thrombosis by hydroxychloroquine sulfate and heparin. Surg Gynecol Obstet 1977; 145: 714-718
    PubMedGoogle Scholar
  • 45 Coe NP, Collins REC, Klein LA, Bettmann MA, Skillman JJ, Shapiro RM, Salzman EW. Prevention of deep vein thrombosis in urological patients: a controlled randomized trial of low dose heparin and external pneumatic compression boots. Surgery 1978; 83: 230-234
    PubMedGoogle Scholar
  • 46 Kakkar VV, Lawrence D, Bentley PG, de Haas HA, Ward VP, Scully MF. A comparative study of low doses of heparin and a heparin analogue in the prevention of postoperative deep vein thrombosis. Thromb Res 1978; 13: 111-122
    CrossrefPubMedGoogle Scholar
  • 47 Salzman EW, Ploetz J, Bettmann M, Skillman J, Klein L. Intraoperative external pneumatic calf compression to afford long-term prophylaxis against deep vein thrombosis in urological patients. Surgery 1980; 87: 239-242
    PubMedGoogle Scholar
  • 48 Nandi P, Wong KP, Wei WI, Ngan H, Ong GB. Incidence of postoperative deep vein thrombosis in Hong Kong Chinese. Br J Surg 1980; 67: 251-253
    CrossrefPubMedGoogle Scholar
  • 49 Borow M, Goldson H. Postoperative venous thrombosis. Am J Surg 1981; 141: 245-251
    CrossrefPubMedGoogle Scholar
  • 50 Butson ARC. Intermittent pneumatic calf compression for prevention of deep venous thrombosis in general abdominal surgery. Am J Surg 1981; 142: 525-527
    CrossrefPubMedGoogle Scholar
  • 51 Hendolin H, Tuppurainen T, Lathinen J. Thoracic epidural analgesia and deep vein thrombosis in cholecystectomized patients. Acta Chir Scand 1982; 148: 405-409
    PubMedGoogle Scholar
  • 52 Kakkar VV, Djazaeri B, Fok J, Fletcher M, Scully MF, Westwick J. 1982 Low molecular weight heparin and prevention of postoperative deep vein thrombosis. Br Med J 1982; 284: 375-379
    CrossrefPubMedGoogle Scholar
  • 53 Onarheim H, Lund T, Heimdal A, Arnesjo B. A low molecular weight heparin for prophylaxis of postoperative deep vein thrombosis. Acta Chir Scand 1986; 152: 593-596
    PubMedGoogle Scholar
  • 54 Sasahara AA, Koppenhagen K, Haring R, Welzel D, Wolf H. Low molecular weight heparin plus dihydroergotamine for prophylaxis of postoperative deep vein thrombosis. Br J Surg 1986; 73: 697-700
    CrossrefPubMedGoogle Scholar
  • 55 Encke A, Breddin K. Comparison of a low molecular weight heparin and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. Br J Surg 1988; 75: 1058-1063
    CrossrefPubMedGoogle Scholar
  • 56 Fricker JP, Vergnes Y, Schach R, Heitz A, Eber M, Grunebaum L, Wiesel ML. Low dose heparin versus low molecular weight heparin in the prophylaxis of thromboembolic complications of abdominal oncological surgery. Eur J Clin Invest 1988; 18: 561-567
    CrossrefPubMedGoogle Scholar
  • 57 Kakkar VV, Stringer MD, Hedges AR, Parker CJ, Welzel D, Hard VP. et al. Fixed combinations of low molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis. Am J Surg 1989; 157: 413-418
    CrossrefPubMedGoogle Scholar
  • 58 Baumgartner A, Jacot N, Moser G, Krahenbuhl B. Prevention of postoperative deep vein thrombosis by one daily injection of low molecular weight heparin and dihydroergotamine. Vasa 1989; 18: 152-156
    PubMedGoogle Scholar
  • 59 Hartl P, Brucke P, Dienstl E, Vinazzer H. Prophylaxis of thromboembolism in general surgery: Comparison between standard heparin and fragmin. Thromb Res 1990; 57: 577-584
    CrossrefPubMedGoogle Scholar
  • 60 McLachlan MSF, Thomson JG, Taylor DW, Kelly ME, Sackett DL. Observer variation in the interpretation of lower limb venograms. AJR 1979; 132: 227-229
    CrossrefPubMedGoogle Scholar
  • 61 Lensing AWA, Büller HR, Prandoni P, Batchelor D, Molenaar AHM, Cogo A. et al. Contrast venography, the gold standard for the diagnosis of deep vein thrombosis: improvement in observer agreement. Thromb Haemostas 1992; 67: 8-12
    PubMedGoogle Scholar
  • 62 Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic and urological surgery. N Engl J Med 1988; 318: 1162-1173
    CrossrefPubMedGoogle Scholar
  • 63 Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Ann Surg 1988; 208: 227-240
    CrossrefPubMedGoogle Scholar