The non-compressibility ratio for accurate diagnosis of lower extremity deep vein thrombosis

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Caecilia Marliana
A. Gunawan Santoso
Santosa Santosa


Accurate identification of patients with deep vein thrombosis (DVT) is critical,
as untreated cases can be fatal. It is well established that the specificity of the clinical signs and symptoms of DVT is low. Therefore, clinicians rely on additional tests to make this diagnosis. There are three modalities for DVT diagnosis; clinical scoring, laboratory investigations, and radiology. The objective of this study was to determine the correlation of plasma D-dimer concentration with the ultrasonographic non-compressibility ratio in patients with DVT in the lower extremities.
This research was a cross-sectional observational study. The sample comprised 25 subjects over 30 years of age with clinically diagnosed DVT in the lower extremities. In all subjects, D-dimer determination using latex enhanced turbidimetric test was performed, as well as ultrasonographic non-compressibility ratio assessment of the lower extremities. Data were analyzed using Pearson’s correlation at significance level of 0.05.
Mean plasma D-dimer concentration was 2953.00 ± 2054.44 μg/L. The highest mean non-compressibility ratio (59.96 ± 35.98%) was found in the superficial femoral vein and the lowest mean non-compressibility ratio (42.68 ± 33.71%) in the common femoral vein. There was a moderately significant correlation between plasma D-dimer level and non-compressibility ratio in the popliteal vein (r=0.582; p=0.037). In the other veins of the lower extremities, no significant correlation was found.
The sonographic non-compressibility ratio is an objective test for quick and accurate diagnosis of lower extremity DVT and for evaluation of DVT severity.

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How to Cite
Marliana, C., Santoso, A. G., & Santosa, S. (2014). The non-compressibility ratio for accurate diagnosis of lower extremity deep vein thrombosis. Universa Medicina, 33(2), 126–132.
Review Article


Heit J, Petterson T, Farmer S, Bailey K, Melton L. Trends in incidence of deep vein thrombosis and pulmonary embolism: a 35-year population-based study. Blood 2006;108:430a.

Heit J, Cohen A, Anderson F. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in

the US. Blood 2005;106:267a.

Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol 2007;44:62-9.doi: 10.1053/j.seminhematol.2007.02.004.

Riddle DL, Wells PS. Diagnosis of lower-extremity deep vein thrombosis in outpatients. Phys Ther 2004;84:729-35.

Kahn S, Shrier I, Julian J, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the post thrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149:


Prandoni P, Noventa F, Ghirarduzzi A, Pengo V, Bernardi E, Pesavento R, et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism : a prospective cohort study in 1626 patients. Haematologica 2007;92:199-205.

Geno M. Diagnostic assessment of deep vein thrombosis and pulmonary embolism. Am J Med 2005;118:S3-12.

Goodacre S, Stevenson M, Wailoo A, Sampson F, Sutton AJ, Thomas S. How should we diagnose suspected deep-vein thrombosis? QJM 2006;99: 377-88.

Falanga A, Zacharski L. Deep vein thrombosis in cancer: the scale of the problem and approaches to management. Ann Oncol 2005;16:696-701.

Subramaniam MR, Chou T, Heath R, Allen R. Importance of pretest probability score and Ddimer assay before sonography for lower limb

deep venous thrombosis. Am J Roentgenol 2006;186:206-12.

Wada H, Kobayashi T, Abe Y, Hatada T, Yamada N, Sudo A, et al. Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis. J Thromb Haemost 2006;4:1253-8.

Sahakian GD, Claessens YE, Allo JC, Kansao J, Kierzek G, Pourriat JL. Accuracy of D-dimers to rule out venous thromboembolism events across age categories. Emergency Med Int 2010, Article ID 185453,4 pages.doi:10.1155/2010/185453.

Kurklinsky AK, Kalsi H, Wysokinski WE, Mauck KF, Bhagra A, Havyer RD, et al. Fibrin D-dimer concentration, deep vein thrombosis symptom

duration, and venous thrombus volume. Angiology 2006;62:253-6.

Chen JD. Ultrasonography in the evaluation of low-extremity deep vein thrombosis. J Chin Med Assoc 2011;74:1-2.

Tsao JH, Tseng CY, Chuang JL, Chen YC, Huang HH, Yi-Hong Chou YH, et al. Non-compressibility ratio of sonography in deep venous thrombosis. J Chin Med Assoc 2010;73:563-7.

Masuda EM, Kistner RL. The case for managing calf vein thrombi with duplex surveillance and selective anticoagulation. Dis Mon 2010;56:601-

Righini M, Paris S, Le Gal G, Laroche JP, Perrier A, Bounameaux H . Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost 2006;95:56-64 . 132

Ouriel K, Green R, Greenberg R, Clair D. The anatomy of deep venous thrombosis of the lower extremity. J Vasc Surg 2000;31:895-900.

Poulikidis KP, Gasparis AP, Labropoulos N.Prospective analysis of incidence, extent and chronicity of lower extremity venous thrombosis.

Phlebology 2014;29:37-42. 20. Kahn S, Shrier I, Julian J, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the post thrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149: 698–707.

Rathbun SW, Whitsett TL, Raskob GE. Negative D-dimer result to exclude recurrent deep venous thrombosis: a management trial. Ann Intern Med 2004;141:839-45.