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Jeffrey S. Ginsberg, MD; Jack Hirsh, MD
Hamilton, Ontario

Philip Wells, MD
Ottawa, Ontario

Arch Intern Med. 1995;155(7):776.

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In reply

We agree with Raskob and associates that the use of serial impedance plethysmography (IPG) is generally a safe approach in patients with suspected venous thromboembolism. Our recommendation that patients with a high pretest probability of deep-vein thrombosis (DVT) and a normal IPG undergo further testing is based on several considerations. First, Raskob and associates fail to cite one study¹ in which the use of serial IPG in 381 consecutive patients with suspected DVT was associated with an unacceptably high rate of venous thromboembolism (10 patients [3.2%]), including four episodes of fatal pulmonary embolism, in follow-up. Although a novel IPG machine was used, its sensitivity for proximal DVT in a preliminary study was 91%, a rate consistent with those reported earlier.² Fatal pulmonary embolism has also been reported in high-risk patients on the day of normal IPG testing.³ Second, our study showed that the sensitivity of . . . [Full Text PDF of this Article]

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