Safely Ruling Out Deep Vein Thrombosis in Pregnancy With the LEFt Clinical Decision Rule and D-Dimer

NCT ID: NCT02507180

Last Updated: 2020-02-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

366 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-09-30

Study Completion Date

2022-01-31

Brief Summary

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This is prospective cohort study in pregnant women who present with signs and symptoms of possible deep vein thrombosis (DVT). All patients will have the same method of assessment of their DVT symptoms (the LEFt clinical decision rule will be applied and D-dimer test will be done) to determine if a compression ultrasound is required. All patients will be followed for a period of 3 months.

Detailed Description

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VTE is a leading cause of maternal death in the developed world. Suspected DVT in pregnancy is a common clinical problem faced by clinicians daily. The only validated method to exclude DVT in pregnancy requires leg vein CUS imaging. This imaging modality is costly and has limited availability (only available in radiology departments and, usually, only during weekday daytime hours) often necessitating referral to the emergency room for initiation of heparin injections until leg vein CUS can be obtained. A simple and seemingly powerful clinical decision rule (LEFt) and a simple blood test (D-dimer) may be promising to exclude DVT in pregnancy without the need for diagnostic imaging. Validating the safety of a simple, non-invasive, widely available approach to suspected DVT in pregnancy would be an important advance in maternal health.

A prospective cohort diagnostic management study in pregnant women with suspected DVT, with three-month follow-up for symptomatic VTE will take place in multiple centres throughout Canada and Europe.

After obtaining informed consent, all patient will have the LEFt clinical decision rule applied by the attending physician and will have D-Dimer testing (D-Dimer results of test performed within 24 hours will be accepted and do not need to be repeated).

Patients with an "unlikely" LEFt score of 0 or 1 point and a negative D-dimer will not undergo diagnostic imaging.

Patients with either a "likely" LEFt score of 2 or 3 points or a positive D-dimer will undergo either a single complete leg vein compression ultrasound (CCUS) (Day 1) or a serial proximal leg vein (CUS) (Day 1 and Day 7).

All patients will be followed for 3 months for symptomatic VTE.

Conditions

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Pregnancy Deep Vein Thrombosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Pregnant women with suspected DVT

Pregnant women presenting with suspected DVT will have the LEFt clinical decision rule applied by the attending physician and will have a clinical D-dimer test done.

LEFt clinical decision rule

Intervention Type OTHER

The LEFt rule

Predictor Points Left leg symptoms +1 Extremity swelling (≥ 2 cm difference in calf circumference +1 First trimester symptom onset +1

Clinical probability Unlikely: 0 or 1 point Likely: \> 1 point

Interventions

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LEFt clinical decision rule

The LEFt rule

Predictor Points Left leg symptoms +1 Extremity swelling (≥ 2 cm difference in calf circumference +1 First trimester symptom onset +1

Clinical probability Unlikely: 0 or 1 point Likely: \> 1 point

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Unselected pregnant women (as self-reported by patient and/or previously documented positive beta hCG on urine or serum pregnancy tests) with
2. Suspected acute symptomatic deep vein thrombosis, defined as:

1. New leg swelling or edema with onset in the last month or,
2. New leg pain (buttock, groin, thigh or calf) with onset in the last month.

Exclusion Criteria

1. Below the age of legal consent in jurisdiction of residence (18 years old for Quebec and 16 years old for rest of Canada)
2. Baseline imaging (imaging done after a minimum of 3 months of treatment for prior proximal DVT) not available if suspected recurrence in the same leg as prior
3. Unable or unwilling to provide informed consent
4. Concomitant symptoms of suspected pulmonary embolism (chest pain or shortness of breath or syncope/pre-syncope or unexplained tachycardia)
5. Therapeutic anticoagulant more than 48 hours.
Minimum Eligible Age

16 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Geneva

OTHER

Sponsor Role collaborator

Leiden University Medical Center

OTHER

Sponsor Role collaborator

Ottawa Hospital Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marc Rodger, MD

Role: PRINCIPAL_INVESTIGATOR

Ottawa Hospital Research Institute

Marc Righini, MD

Role: PRINCIPAL_INVESTIGATOR

Hopitaux Universitaires de Geneve

Locations

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Intermountain Healthcare, Inc.

Murray, Utah, United States

Site Status NOT_YET_RECRUITING

Foothills Medical Centre

Calgary, Alberta, Canada

Site Status RECRUITING

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Children's and Women's Health Centre of British Columbia

Vancouver, British Columbia, Canada

Site Status RECRUITING

Queen Elizabeth II Health Science Centre

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Hamilton Health Sciences Centre

Hamilton, Ontario, Canada

Site Status RECRUITING

London Health Sciences Centre

London, Ontario, Canada

Site Status WITHDRAWN

Ottawa Hospital Research Institute

Ottawa, Ontario, Canada

Site Status RECRUITING

Sunnybrook Medical Hospital

Toronto, Ontario, Canada

Site Status WITHDRAWN

Jewish General Hospital

Montreal, Quebec, Canada

Site Status RECRUITING

Leiden University Medical Center

Leiden, , Netherlands

Site Status RECRUITING

Hopitaux Universitaires de Geneve

Geneva, , Switzerland

Site Status RECRUITING

Countries

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United States Canada Netherlands Switzerland

Central Contacts

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Marc A Rodger, MD

Role: CONTACT

514-843-1578

Veronica Bates, BSc

Role: CONTACT

613-737-8899 ext. 71068

Facility Contacts

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Scott Stevens, MD

Role: primary

Jessica Lee, BA

Role: primary

Alissa Kazakoff, BSc

Role: backup

Shauna Littlefair, RN

Role: primary

Frannie MacKenzie

Role: primary

Blaine Gallant, RN

Role: primary

Carolyn Webb, RN

Role: primary

Veronica Whitham, BSc

Role: primary

Carla Strulovitch, RN

Role: primary

Erik Klok, MD

Role: primary

Louise Riberdy, MD

Role: primary

Other Identifiers

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20150546-01H

Identifier Type: -

Identifier Source: org_study_id

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