Diagnosis of deep vein thrombosis with a new radionuclide method--99Tcm-albumin test

The diagnostic efficiency of 99Tcm-albumin test (AT), a new radionuclide method, was evaluated in 90 consecutive patients with suspected deep vein thrombosis (DVT) admitted to the medical emergency ward. Phlebography was used as reference method. The sensitivity of the AT test was 92% and the specificity was 61%. As the method is objective, rapid and convenient for the patients, it can be recommended as an initial examination method to be followed by phlebography, in cases with a positive test result. Criteria with high specificity, 98%, have also been defined but these criteria should be further investigated.

The clomethiazole acute stroke study (CLASS): Efficacy results in 545 patients classified as total anterior circulation syndrome (TACS)

The CLASS study showed no significant difference between treatment groups for the neuroprotectant clomethiazole compared with placebo. However, a beneficial effect of the drug was seen in patients with total anterior circulation syndrome (TACS). These are patients with clinical symptoms suggesting a large stroke. Full results of this subgroup analysis are reported. Patients were classified before randomization using clinical symptoms into the stroke syndromes TACS, partial anterior circulation syndrome, and lacunar syndrome. Subgroup analyses of stroke syndromes were performed post hoc after detecting a treatment by severity interaction. The primary efficacy variable was relative functional independence defined as the proportion of patients scoring > or =60 on the Barthel Index at 90 days. TACS patients (n=546, 40% of all CLASS patients) were more severe at baseline on the 58 point Scandinavian Stroke Scale compared with non-TACS patients (median difference 10 points, mean difference 10.9 points, SE=0.6). Outcome for TACS patients treated with placebo was poor, with only 29.8% reaching relative functional independence. This was increased to 40.8% in the clomethiazole group, a 37% relative benefit, which is clinically significant (odds ratio=1.62, 95% CI 1.13-2.31, nominal P=.008). There was little or no difference in the outcome of non-TACS patients treated with clomethiazole compared with placebo. The treatment effect in TACS patients was quite consistent across participating countries and the 3 parts of the study defined by the 2 interim analyses. The treatment effect seen in patients with clinical symptoms suggesting a large stroke (TACS) is biologically plausible but requires confirmation in a prospective study which is ongoing.

Out-patient treatment of acute deep vein thrombosis

BACKGROUND

To assess whether uncomplicated deep vein thrombosis could be treated in an out-patient setting without increasing the frequency of complications, and to determine the proportion of patients with deep vein thrombosis, traditionally treated as in-patients at the Departments of Medicine, who are eligible for such treatment.

METHODS

In a multicentre study, carried out at six hospitals of varying sizes and serving a population of about 600,000, consecutive patients over 18 years of age, with verified deep vein thrombosis, primarily presented as acute cases at the respective Departments of Medicine, were considered for treatment on an out-patient basis during a 1-year period.

INTERVENTIONS

Those eligible for out-patient treatment were put on low molecular weight heparin and oral anticoagulants, and scheduled for daily attendance at the out-patient clinic of the respective Dept. of Medicine. Details of any complication were recorded according to a standard check-list. The patients underwent a full checkup at three-month follow-up.

MAIN OUTCOME MEASURES

Any bleeding event or pulmonary embolism. Progress of thrombosis.

RESULTS

Of 523 patients considered for out-patient treatment, 126 (24%) were excluded according to the defined exclusion criteria, 197 (38%) were treated entirely on an out-patient basis, and another 43 (8%) were initially treated in hospital (median two days) before being transferred to the out-patient setting. Three patients had to be hospitalized for suspected complications, but none of these turned out to be serious. No serious bleeding event or thromboembolic complication was registered.

CONCLUSIONS

Uncomplicated acute deep vein thrombosis could be safely treated on an out-patients basis. At least 50% of the patients with this diagnosis, former treated as in-patients at the Depts. of Medicine, are eligible for such treatment.