Objective. To assess the performance of extended lower limb venous ultrasound (US) for the diagnosis of asymptomatic deep vein thrombosis (DVT) and to estimate a 3-month DVT incidence on repeated US after total hip replacement.Design. Diagnostic performance study and prospective cohort study.Materials and methods. US was compared to phlebography in 70 consecutive patients and interobserver agreement was assessed in the last 48 patients at day 8. US was repeated in these 48 patients at day 13 and day 90.Results. Phlebography demonstrated a DVT in 18170 (26%) patients, with five proximal and 13 distal and US in 23170 (33%) patients, with eight proximal and 15 distal. Sensitivity and specificity of US with 95% Cl were 94% (73-100) and 89% (76-96), respectively. Sensitivity in isolated distal vein thrombosis was 92% (67-99). The Kappa coefficient for agreement between observers was 0.84 (0.66-1.00). Follow-up showed a DVT in 15148 (31%) patients on day 8, in 20148 patients (42%) on day 13. DVT recurred in two patients during follow-up.Conclusions. The incidence of asymptomatic DVT is still significant despite prophylaxis but most DVTs remain distal and occur in the first 2 weeks. Extended US could replace phlebography for systematic screening in clinical trials using surrogate endpoints in view of its high accuracy and reliability.

Les anomalies veineuses des membres inférieurs regroupent un ensemble d'altérations morphologiques ou fonctionnelles des veines superficielles et/ou profondes dont l'origine est en rapport avec un arrêt, à un stade plus ou moins tardif, de leur morphogenèse. Elles s'intègrent dans le vaste registre des malformations veineuses. Ces lésions, sporadiques et rares, peut-être liées à une altération génétique à expression variable, sont tantôt latentes et de découverte fortuite, ou symptomatiques entraînant alors un tableau d'insuffisance veineuse chronique sévère. Elles peuvent être isolées, ou s'inscrire dans un tableau de malformation complexe. Leur évaluation a largement bénéficié de l'utilisation des méthodes échographiques et de l'angiographie par résonance magnétique nucléaire, permettant de distinguer les formes où l'abstention thérapeutique est de mise, et celles où un geste, médical, interventionnel ou chirurgical s'impose.

Due to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p < 0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.