Screening for Occult Malignancy in Patients With Idiopathic Venous Thromboembolism: an Open Randomized Controlled Trial Using a Comprehensive Abdomen/Pelvis Computed Tomography
Inclusion Criteria:
- Patients with a new diagnosis of unprovoked proximal deep vein thrombosis (DVT) or
pulmonary embolism (PE) will be eligible to participate into the study:
- Unprovoked VTE is defined as the absence of any of the following predisposing
factors:
1. known active cancer;
2. recent (less than 3 months) paralysis, paresis or plaster immobilization of
the lower extremities;
3. recently bedridden for period of 3 or more days, or major surgery, within
the previous 12 weeks requiring general or regional anaesthesia;
4. previous unprovoked VTE;
5. known thrombophilia (hereditary or acquired)
- Proximal DVT is defined as a non-compressibility of any vein segment from the
common femoral vein to the trifurcation of the popliteal vein or a persistent
intra-luminal filling defect of the iliac, common femoral, superficial femoral
or popliteal veins on contrast venography.
- Pulmonary embolism is defined as:
1. patients with a high/intermediate pre-test probability (Wells' model > 4) +
high probability V/Q scan;
2. positive pulmonary angiogram; or
3. spiral CT demonstrating intraluminal filling defect in a vessel larger than
a segmental artery
Exclusion Criteria:
Patients will be excluded from the study if they have any of the following criteria:
- Age < 18 years-old;
- Refusal or inability to provide informed consent;
- Allergy to contrast media;
- Creatinine clearance < 60 ml/min;
- Claustrophobia or agoraphobia;
- Weight > 130 kg;
- Diagnosis of ulcerative colitis; and
- Diagnosis of glaucoma
- Current pregnancy