• AAA
• Aorta
• Aortic aneurysm
• DVT
• Deep vein thrombosis
• POCUS
• Point of care ultrasound
• Ultrasound

• artificial intelligence
• clinical (general)
• diagnosis
• screening
• venous thrombosis

• Anticoagulants
• Gynecologic Neoplasms
• Gynecologic Surgery
• Pulmonary Embolism
• Venous Thromboembolism

• Humans
• Female
• Pulmonary Embolism/prevention & control
• Pulmonary Embolism/etiology
• Middle Aged
• Genital Neoplasms, Female/surgery
• Genital Neoplasms, Female/complications
• Venous Thromboembolism/prevention & control
• Venous Thromboembolism/etiology
• Aged
• Prospective Studies
• Postoperative Complications/prevention & control
• Postoperative Complications/etiology
• Heparin, Low-Molecular-Weight/administration & dosage
• Heparin, Low-Molecular-Weight/therapeutic use
• Anticoagulants/administration & dosage
• Anticoagulants/therapeutic use
• Adult
• Pyridines/administration & dosage
• Pyridines/therapeutic use
• Thiazoles/administration & dosage
• Thiazoles/therapeutic use
• Heparin/administration & dosage
• Heparin/therapeutic use
• Japan/epidemiology

• Daiichi-Sankyo

• Deep vein thrombosis
• Diagnostic accuracy
• Emergency medicine
• Learning curve
• Point-of-care ultrasound

• Humans
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/economics
• Venous Thrombosis/mortality
• Cost-Benefit Analysis
• Female
• Male
• Middle Aged
• Ultrasonography/economics
• Prospective Studies
• Aged
• Health Care Costs
• Recurrence
• Adult
• Decision Support Techniques
• Anticoagulants/therapeutic use
• Anticoagulants/economics
• Hemorrhage/economics
• Predictive Value of Tests

• D-dimer
• compression ultrasonography
• deep vein thrombosis
• pretest clinical probability
• venous thromboembolism

• Humans
• Venous Thrombosis/diagnosis
• Venous Thrombosis/epidemiology
• Female
• Male
• Retrospective Studies
• Aged
• Lower Extremity/blood supply
• Middle Aged
• Fibrin Fibrinogen Degradation Products/analysis
• Sex Factors
• Ultrasonography
• Aged, 80 and over
• Adult

• Calf deep vein thrombosis
• anticoagulant therapy
• compression ultrasound
• diagnosis
• direct oral anticoagulants
• distal deep vein thrombosis

• Humans
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/drug therapy
• Anticoagulants/therapeutic use
• Risk Factors
• Treatment Outcome
• Recurrence
• Risk Assessment
• Hemorrhage/chemically induced

• acute care physician
• core items
• ultrasound education

• University Hospital S. Orsola-Malpighi-IRCCS, Bologna, Italy

• anticoagulation
• deep vein thrombosis (DVT)
• diabetes mellitus
• fibrinogen (FBG)
• residual venous thrombosis
• trauma

• critical care
• critical care monitoring
• echocardiography
• glycogen storage disease type II
• heart transplantation
• intracranial pressure
• ultrasound

Isolated distal deep vein thrombosis (IDDVT), a disease frequently detected in hospitalized patients, can progress to proximal deep vein thrombosis (PDVT) and pulmonary embolism (PE). Here, we evaluated the effects of anticoagulation in hospitalized IDDVT patients.

We conducted a retrospective study in our hospital and enrolled hospitalized IDDVT patients diagnosed by compression ultrasonography (CUS) from January to December 2020. Participants were divided into anticoagulation (AC) and non-anticoagulation (non-AC) groups. After propensity score matching (PSM), multivariate Cox regression analyses were performed to assess whether anticoagulation was associated with PDVT/PE, and all-cause mortality.

A total of 426 IDDVT inpatients with CUS follow-up were screened from 1502 distal DVT patients and finally enrolled. The median age was 67 years with 51.4% males and 15.5% cancer patients. The median follow-up was 11.6 months. There were 288 and 138 patients treated with or without anticoagulants, respectively. Patients in the non-AC group had less body mass index and more comorbidities. Patients in the AC group were treated with rivaroxaban or dabigatran (52.1%), low molecular weight heparin (42.7%), and warfarin (5.2%). The PSM generated 111 pairs of well-matched IDDVT patients with or without anticoagulation. The Kaplan–Meier analysis demonstrated that neither the incidence of PDVT/PE (5.4% vs. 2.7%, log-rank p = 0.313) nor all-cause mortality (27.9% vs. 18.9%, log-rank p = 0.098) was significant different between groups. Anticoagulation was not associated with PDVT/PE and all-cause mortality in the multivariable Cox regression analyses using the matched cohorts. The main risk factors for all-cause mortality were age, malignancy history, BMI, sepsis, heart failure, and white blood cell (WBC) count.

In hospitalized IDDVT patients, the thrombosis extension rate to PDVT/PE was low. Anticoagulation did not reduce the incidence of thrombosis extension of IDDVT and was not associated with all-cause mortality.

The online version contains supplementary material available at 10.1186/s12959-022-00410-1.

• Anticoagulation
• Inpatients
• Isolated distal deep vein thrombosis
• Mortality
• Proximal deep vein thrombosis
• Pulmonary embolism

• DVT
• deep vein thrombosis
• lower extremity ultrasound

• Humans
• Retrospective Studies
• Popliteal Vein/diagnostic imaging
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/epidemiology
• Ultrasonography/methods
• Lower Extremity/blood supply

• Fibrin Fibrinogen Degradation Products
• Humans
• Lower Extremity/diagnostic imaging
• Predictive Value of Tests
• Retrospective Studies
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/epidemiology

• Deep vein thrombosis
• Gastrointestinal cancers
• Pulmonary thromboembolism
• Ultrasonography

Venous thromboembolism (VTE) is a major complication in patients with malignant tumors and orthopedic disorders. Although it is known that patients undergoing surgery for malignant musculoskeletal tumor are at an increased risk of thromboembolic events, only few studies have investigated this risk in detail. Therefore, the aim of this study was to determine the prevalence and risk factors for preoperative VTE in malignant musculoskeletal tumors patients.

We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for malignant musculoskeletal tumor, have undergone measurements of preoperative D-dimer levels, and were subsequently screened for VTE by lower extremity venous ultrasonography and/or contrast-enhanced computed tomography scans. Statistical analyses were performed to examine the prevalence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the D-dimer cutoff value for the diagnosis of VTE.

Overall, 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors, and 12 with hematologic malignancies) were included. D-dimer levels were high in 79 patients; VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that age ≥ 60 years (P = 0.021) and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the D-dimer cutoff value for the diagnosis of VTE was 1.53 µg/mL; the sensitivity and specificity were 89.5% and 79.4%, respectively.

Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in malignant musculoskeletal tumors patients. D-dimer levels were not associated with VTE in the multivariate analysis, likely because they are affected by a wide variety of conditions, such as malignancy and aging. D-dimer is useful for exclusion diagnosis because of its high sensitivity, but patients with high age and tumor location in the lower limbs are a high-risk group and should be considered for imaging evaluation such as ultrasonography regardless of D-dimer levels.

Our study was approved by the institutional review board. The registration number is B200600056. The registration date was July 13, 2020.

The online version contains supplementary material available at 10.1186/s12959-022-00382-2.

• D-dimer
• DVT
• Deep vein thrombosis
• Malignant musculoskeletal tumor
• Preoperative venous thromboembolism
• VTE

The ongoing rapid expansion of point-of-care ultrasound (POCUS) and its corresponding supporting literature leaves the frontline clinician in a difficult position when trying to keep abreast of the latest developments. Our group of POCUS experts has selected ten influential POCUS-related papers from the past twelve months and provided a short summary of each. Our aim is to give to emergency physicians, intensivists, and other acute care providers key information, helping them to keep up to date on rapidly evolving POCUS literature.

• medical education
• point-of-care ultrasound (POCUS)
• ultrasound

• Anticoagulants
• Arthroplasty, Replacement, Hip
• Arthroplasty, Replacement, Knee
• Humans
• Knee Joint
• Postoperative Complications
• Venous Thromboembolism

• Intramuscular hematoma
• trauma
• ultrasound

The use of ultrasonography in the intensive care unit (ICU) is steadily increasing but is usually restricted to examinations of single organs or organ systems. In this study, we combine the ultrasound approaches the most relevant to ICU to design a whole-body ultrasound (WBU) protocol. Recommendations and training schemes for WBU are sparse and lack conclusive evidence. Our aim was therefore to define the range and prevalence of abnormalities detectable by WBU to develop a simple and fast bedside examination protocol, and to evaluate the value of routine surveillance WBU in ICU patients.

A protocol for focused assessments of sonographic abnormalities of the ocular, vascular, pulmonary, cardiac and abdominal systems was developed to evaluate 99 predefined sonographic entities on the day of admission and on days 3, 6, 10 and 15 of the ICU admission. The study was a clinical prospective single-center trial in 111 consecutive patients admitted to the surgical ICUs of a tertiary university hospital.

A total of 3003 abnormalities demonstrable by sonography were detected in 1275 individual scans of organ systems and 4395 individual single-organ examinations. The rate of previously undetected abnormalities ranged from 6.4 ± 4.2 on the day of admission to 2.9 ± 1.8 on day 15. Based on the sonographic findings, intensive care therapy was altered following 45.1% of examinations. Mean examination time was 18.7 ± 3.2 min, or 1.6 invested minutes per detected abnormality.

Performing the WBU protocol led to therapy changes in 45.1% of the time. Detected sonographic abnormalities showed a high rate of change in the course of the serial assessments, underlining the value of routine ultrasound examinations in the ICU.

Trial registration The study was registered in the German Clinical Trials Register (DRKS, 7 April 2017; retrospectively registered) under the identifier DRKS00010428.

The online version contains supplementary material available at 10.1186/s13054-021-03811-2.

• Critical care
• Critical care echocardiography
• General critical care ultrasound
• Intensive care medicine
• Sonography
• Ultrasound
• Whole-body ultrasound

To provide consensus, and a list of experts’ recommendations regarding the basic skills for head-to-toe ultrasonography in the intensive care setting.

The Executive Committee of the European Society of Intensive Care (ESICM) commissioned the project and supervised the methodology and structure of the consensus. We selected an international panel of 19 expert clinicians–researchers in intensive care unit (ICU) with expertise in critical care ultrasonography (US), plus a non-voting methodologist. The panel was divided into five subgroups (brain, lung, heart, abdomen and vascular ultrasound) which identified the domains and generated a list of questions to be addressed by the panel. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Statements were classified as a strong recommendation (84% of agreement), weak recommendation (74% of agreement), and no recommendation (less than 74%), in favor or against.

This consensus produced a total of 74 statements (7 for brain, 20 for lung, 20 for heart, 20 for abdomen, 7 for vascular Ultrasound). We obtained strong agreement in favor for 49 statements (66.2%), 8 weak in favor (10.8%), 3 weak against (4.1%), and no consensus in 14 cases (19.9%). In most cases when consensus was not obtained, it was felt that the skills were considered as too advanced. A research agenda and discussion on training programs were implemented from the results of the consensus.

This consensus provides guidance for the basic use of critical care US and paves the way for the development of training and research projects.

The online version contains supplementary material available at 10.1007/s00134-021-06486-z.

• Abdominal ultrasound
• Brain ultrasound
• Consensus
• Echocardiography
• Intensive care unit
• Lung ultrasound
• Ultrasonography
• Vascular ultrasound

It remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT.

In this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients’ electronic charts.

DVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT.

Isolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.

• Compression ultrasound
• Deep venous thrombosis
• Duplex ultrasound

• COVID-19
• thoracic medicine
• ultrasound

• Adult
• COVID-19
• Emergency Service, Hospital
• Humans
• Lung/diagnostic imaging
• Prospective Studies
• SARS-CoV-2
• Ultrasonography

• Deep venous thrombosis
• Emergency department
• Lower extremity
• Two-point compression ultrasonography

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

• Compression ultrasound
• Deep venous thrombosis
• Venous ultrasound
• Venous thromboembolism
• Critical care ultrasonography

• Anticoagulants/adverse effects
• Anticoagulants/therapeutic use
• Hemorrhage/blood
• Hemorrhage/chemically induced
• Humans
• Neoplasms/complications
• Neoplasms/drug therapy
• Risk Factors
• Venous Thrombosis/blood
• Venous Thrombosis/drug therapy
• Venous Thrombosis/etiology

• DVT
• critical care
• pulmonary embolism
• training (int. med.)
• ultrasound

Background  Isolated distal deep vein thromboses (IDDVT) are frequently diagnosed; however, their natural history and real risk of complications are still uncertain. Though treatment is still not well standardized, international guidelines recommend no more than 3 months of anticoagulation therapy. We investigated how Italian clinicians treat IDDVT patients in their real life in our country.

Methods  Baseline characteristics and clinical history of the patients enrolled in the prospective, observational, multicenter START-Register for a first IDDVT or proximal DVT (PDVT) were analyzed.

Results  Overall, 412 IDDVT patients were significantly younger, with better renal function, and more frequent major transient risk factors, when compared with 1,173 PDVT patients. The anticoagulation duration was >180 days in 52.7% of IDDVT patients (70.7% in PDVT). During treatment, bleeding occurred in 5.6 and 2.8% patient-years in IDDVT and PDVT, respectively ( p  = 0082). Bleeding was more frequent in IDDVT than PDVT patients treated with warfarin (6.8 vs. 3.2 patient-years, p  = 0.0228, respectively). Thrombotic complications occurred in 1.1 and 2.4% patient-years in IDDVT and PDVT patients, respectively. Analyzing together the two groups, 66.1% of bleeds and 86.1% thrombotic complications occurred after 90 days anticoagulation treatment.

Conclusion  The large majority of IDDVT patients received anticoagulation for more than 3 months. Most bleeding and thrombotic complications occurred after the first 90 days of anticoagulation therapy. These results indicate that an extended anticoagulation beyond 90 days in IDDVT patients is associated with increased risk of complications. Whether an extended treatment may lower recurrences after anticoagulation withdrawal should be assessed by specifically designed studies.

• bleeding
• duration of treatment
• isolated distal deep vein thrombosis
• oral anticoagulant

The changes in the coagulation, fibrinolytic, and endothelial functions are correlated with the pathophysiology of the thromboembolic diseases during acute illness. However, these changes in patients with hereditary thrombophilia who were not in the acute stage of venous thromboembolism (VTE) are unclear. A panel of 4 biomarkers, including thrombin–antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), tissue-type plasminogen activator/plasminogen activator inhibitor-1 complex (t-PAIC), and soluble thrombomodulin (sTM), were assayed in 100 healthy controls and 100 patients with thrombophilia. Although significantly higher concentrations of TAT, PIC, t-PAIC, and sTM were observed in patients with thrombophilia than in healthy controls, 70 patients showed absolutely normal levels of the above 4 biomarkers. Among the other 30 patients who had at least 1 biomarker out of the corresponding reference interval, 26 of them presented elevated PIC with or without increased TAT. Except for sTM, other 3 biomarkers did not show significant differences in patients with previous VTE compared to those without. Patients with single episode of VTE had obviously lower t-PAIC than those with multiple episodes of VTE, whereas the levels of TAT, PIC, and sTM were unassociated with the number of thrombosis episodes. Most thrombophilia patients who were not in the acute stage of VTE showed normal coagulation, fibrinolytic, and endothelial functions. Thus, we were unable to show that the one-time response of this panel was clinically helpful in determining thrombosis risk in thrombophilia individuals. Future studies should focus on the dynamic monitoring during the chronic phase of VTE to offer special advantages for patients with thrombophilia.

• anticoagulants
• coagulation
• endothelium
• fibrinolysis
• thrombophilia
• venous thromboembolism

• Anticoagulation
• Aspirin
• Deep venous thrombosis
• Infrapopliteal DVT
• Venous thromboembolism

One of the most prominent and concerning complications associated with coronavirus disease 2019 (COVID-19) is venous and arterial thromboembolisms. The aim of the present study was to delineate the prevalence of thromboembolic events and the current status of prophylactic anticoagulation therapy in patients with COVID-19 in Japan.

Between February 1 and August 31, 2020, we performed a dual-center, retrospective cohort study based on data obtained from the medical charts of COVID-19 patients admitted to healthcare facilities in Japan. The primary outcome was any thromboembolic event including pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction, ischemic stroke and other systemic thromboemboli.

During the study period, we extracted 628 consecutive patients admitted for COVID-19. Prophylactic anticoagulant therapy was administered in 63 (10%) patients of whom 20 (31.7%) were admitted to the intensive care unit (ICU). Thromboembolic events occurred in 18 (2.9%) patients (14.3% of patients in ICU and 2.2% of patients in the general wards). DVT were detected in 13 (2.1%) patients, PE in 11 (1.8%), and both DVT and PE in 6 (0.96%) patients. An increasing prevalence in thromboembolic events was noted with progressive clinical severity. Overall in-hospital mortality was 4.8%.

Prophylactic anticoagulation therapy was administered in only 10% of all hospitalized COVID-19 patients. The prevalence of any thromboembolic events was 2.9% in COVID-19 patients with most events occurring in severe and critical patients. Therefore, prophylactic anticoagulation therapy may be warranted in severe and critical patients but in asymptomatic to moderate patients the practice remains controversial.

• Asia
• COVID-19
• Deep vein thrombosis
• Japan
• Pulmonary embolism
• Venous thromboembolism

• Diagnosis
• Distal deep vein thrombosis
• Management
• Outcome

• DVT
• General practitioner
• LCUS
• POCUS
• Postgraduate medical education
• Primary health care

L’infection COVID-19 s’accompagne d’un sur-risque thrombotique veineux mais également artériel et microvasculaire.

L’inflammation marquée des formes graves s’accompagne d’une augmentation des D-dimères qui pourrait constituer un indicateur du risque thrombotique.

Un patient COVID-19 avéré ou suspect présentant des signes cliniques évoquant une complication thrombotique veineuse doit être hospitalisé pour bilan diagnostique.

La réalisation d’une échographie-Doppler veineuse chez un patient COVID-19 avéré ou suspect nécessite la protection de l’opérateur et la désinfection du matériel postérieurement à l’examen.

L’angioscanner pulmonaire est l’examen de choix chez le patient COVID-19 suspect d’embolie pulmonaire.

Un traitement anticoagulant prophylactique est indiqué chez tout patient COVID-19 hospitalisé.

Un traitement anticoagulant prophylactique renforcé est proposé chez les patients COVID-19 additionnant des facteurs de risque de thrombose veineuse et notamment obèses.

La prolongation du traitement anticoagulant prophylactique après la sortie de l’hôpital est proposée chez les malades COVID-19 additionnant des facteurs de risque de thrombose veineuse.

Le traitement anticoagulant curatif fait appel aux héparines de bas poids moléculaire, anticoagulants oraux directs ou antivitamines K pendant une durée de trois à six mois.

Une attention particulière doit être portée aux risques d’interactions entre anticoagulants et médicaments de l’infection COVID-19 (ex antirétroviraux ou anti-cytokines).

In patients with suspected venous thromboembolism, the goal is to accurately and rapidly identify those with and without thrombosis. Failure to diagnose venous thromboembolism (VTE) can lead to fatal pulmonary embolism (PE), and unnecessary anticoagulation can cause avoidable bleeding. The adoption of a structured approach to VTE diagnosis, that includes clinical prediction rules, D-dimer testing and non-invasive imaging modalities, has enabled rapid, cost-effective and accurate VTE diagnosis, but problems still persist. First, with increased reliance on imaging and widespread use of sensitive multidetector computed tomography (CT) scanners, there is a potential for overdiagnosis of VTE. Second, the optimal strategy for diagnosing recurrent leg deep venous thrombosis remains unclear as is that for venous thrombosis at unusual sites. Third, the conventional diagnostic approach is inefficient in that it is unable to exclude VTE in high-risk patients. In this review, we outline pragmatic approaches for the clinician faced with difficult VTE diagnostic cases. In addition to discussing the principles of the current diagnostic framework, we explore the diagnostic approach to recurrent VTE, isolated distal deep-vein thrombosis (DVT), pregnancy associated VTE, subsegmental PE, and VTE diagnosis in complex medical patients (including those with impaired renal function).

• deep-vein thrombosis
• diagnosis
• pulmonary embolism
• venous thromboembolism

Despite thromboprophylaxis, patients with coronavirus disease 2019 (COVID‐19) exhibit hypercoagulability and higher venous thromboembolic risk, although its real incidence is still unknown. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) in patients with COVID‐19 admitted to both intensive care units (ICUs) and medical wards (MWs). Consecutive patients admitted for COVID‐19 to the MW and the ICU at Padua University Hospital, all receiving thromboprophylaxis, underwent systematic ultrasonography of the internal jugular, and the upper and lower limbs veins every 7 days (± 1 day) after the admission; and, if negative, once‐weekly until discharge or death. In case of suspected pulmonary embolism, a multidetector computed tomographic angiography was performed. The primary outcome was the proportion of any deep‐vein thrombosis (DVT) and symptomatic pulmonary embolism in both groups. An extended blood coagulative test was performed as well. From March 4 to April 30, 2020, a total of 85 patients were investigated, 44 (52%) in MWs and 41 (48%) in the ICU. Despite thromboprophylaxis, VTE occurred in 12 patients in the MWs (27.3%) and 31 patients in the ICU (75.6%) with an odds ratio of 9.3 (95% confidence interval (CI) 3.5–24.5; P < 0.001). Multiple‐site DVT occurred in 55.6% of patients (95% CI 39.6–70.5). Increased D‐dimer levels significantly correlated with VTE (P = 0.001) and death (P = 0.015). Summarizing, patients with COVID‐19 admitted to the MW or ICU showed a high frequency of venous thromboembolism, despite standard‐dose or high‐dose thromboprophylaxis. Whether thrombosis, particularly asymptomatic events, may play a role in the morbidity and mortality of patients with COVID‐19 remain to be clarified.

Suspicion of deep vein thrombosis (DVT) is common and requires urgent and efficient investigation due to hazardous prognosis. The traditional diagnostic pathway can be complex and time-consuming, and innovative solutions may provide easy access to diagnostics and better use of healthcare resources. We aimed to describe use, clinical outcomes and time used when providing general practitioners (GPs) with a direct-access pathway to hospital-based, single whole-leg compression ultrasound (CUS) for patients with suspected DVT. Furthermore we aimed to describe the resources used in the new direct-access pathway and compare it with the previous pathway.

We conducted a 2-year descriptive cohort study (2016–2017) including 449 consecutively referred patients for diagnosis of DVT in a Danish regional hospital. The previous pathway included pre-test at the medical department, a proximal leg CUS if required based on the pre-test and a re-scan if the first CUS was negative. The new pathway included two strategies: 1) a ‘yes-no strategy’, where GPs referred patients directly to whole-leg CUS and if positive, treated at the medical department and if negative, discharged to the GP, 2) a ‘follow-up strategy’ where GPs could require that patients were seen at the medical department, irrespective of the CUS result. Data included extractions from the Radiology Information and Patient Administrative Systems, and mean salaries of healthcare professionals at Silkeborg Regional Hospital, Denmark. Descriptive statistics were used to describe prevalence, timelines and costs.

GPs referred 318 (71%) patients through the yes-no strategy and 131 (29%) via the follow-up strategy with DVT diagnosed in 48 (15%) and 51 (39%) patients, respectively (p < 0.001). For the 263 patients completed after CUS in the yes-no strategy, median pathway time was 24 min (IQI: 16–36), and for those with DVT (including both strategies) 202 min (IQI: 158–273). Direct-access pathway costs were €49.7 less per patient than the previous pathway.

Direct-access to CUS for suspected DVT was achievable, had short time intervals and required fewer resources. The difference in DVT prevalence indicates that GPs distinguish between patients with low and high risk of DVT.

• Clinical decision-making
• Denmark
• Diagnosis
• General practice
• Ultrasonography
• Venous thrombosis

Deep vein thrombosis (DVT) is prevalent in patients with coronavirus disease 2019 (COVID-19). However, the risk factors and incidence rate of DVT remains elusive. Here, we aimed to assess the incidence rate and risk factors of DVT. All patients diagnosed with COVID-19 and performed venous ultrasound by ultrasound deparment between December 2019 and April 2020 in Wuhan Jin Yin-tan hospital were enrolled. Demographic information and clinical features were retrospectively collected. Notably, a comparison between the DVT and the non-DVT groups was explored. The incidence rate of venous thrombosis was 35.2% (50 patients out of 142). Moreover, the location of thrombus at the proximal extremity veins was 5.6% (n = 8), while at distal extremity veins was 35.2% (n = 50) of the patients. We also noted that patients with DVT exhibited a high level of D-dimer (OR 10.9 (95% CI, 3.3-36.0), P < 0.001), were admitted to the intensive care unit (OR 6.5 (95% CI, 2.1-20.3), P = 0.001), a lower usage of the anticoagulant drugs (OR 3.0 (95% CI, 1.1-7.8), P < 0.001). Finally, this study revealed that a high number of patients with COVID-19 developed DVT. This was observed particularly in critically ill patients with high D-dimer levels who required no anticoagulant medication.

• COVID-19
• deep vein thrombosis (DVT)
• incidence rate
• risk factors
• ultrasound

To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp.

Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B.

Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups.

CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.

• ASIR-V
• CT venography
• Deep vein thrombosis
• Image reconstruction
• Radiation dose

• Clinical probability
• D dimer
• Deep venous thrombosis
• Diagnosis
• Diagnóstico
• Dímero D
• Ecografía por compresión
• Probabilidad clínica
• Trombosis venosa profunda
• Ultrasonography