Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group

Ann Intern Med. 1992 Nov 1;117(9):735-8. doi: 10.7326/0003-4819-117-9-735.


Objective: To evaluate the ability of color Doppler ultrasound to detect proximal deep venous thrombosis (DVT) in asymptomatic high-risk patients who subsequently underwent contrast venography.

Design: Prospective cohort study using blinded observers, with contrast venography as the comparison standard.

Setting: Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT.

Patients: A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement.

Measurements: Ten days after surgery or before hospital discharge (whichever occurred first), patients had bilateral color Doppler ultrasound examinations of the proximal veins of the lower extremities. Subsequently, a contrast venogram of the operated leg was obtained.

Results: Color Doppler ultrasound studies and venograms were both evaluable in 319 of the 385 patients. Deep venous thrombosis was identified by contrast venography in 80 patients (prevalence, 25%; 95% CI, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; CI, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; CI, 18% to 62%), moderately good specificity (92%; CI, 89% to 95%), and a poor positive predictive value for this population (26%).

Conclusion: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Color
  • Heparin / therapeutic use
  • Hip Prosthesis
  • Humans
  • Knee Prosthesis
  • Phlebography / methods
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / prevention & control
  • Predictive Value of Tests
  • Risk Factors
  • Thrombophlebitis / diagnostic imaging*
  • Thrombophlebitis / prevention & control
  • Ultrasonography / methods
  • Warfarin / therapeutic use


  • Warfarin
  • Heparin