Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 1, pp 96–101 | Cite as

Ruling out deep vein thrombosis in patients with superficial vein thrombosis: external validation of the ICARO score

  • Paul FrappéEmail author
  • Quentin Brosse
  • Benjamin Seffert
  • Hervé Décousus
  • Laurent Bertoletti
  • STEPH Study Group


A clinical score was recently proposed to rule out concomitant DVT in patients with a clinical suspicion of SVT. This study aimed to assess the external validity of this score in patients from the STEPH study. We performed a post-hoc analysis of data from the STEPH study. The STEPH study was a prospective multicenter community-based study conducted during a 1-year period in the resident adult population of the Greater Saint-Etienne urban area (France). Every patient with a clinical suspicion of SVT underwent a venous compression ultrasonography, to confirm SVT and to assess the presence of a concomitant DVT or not. Odds ratios for concomitant DVT were calculated for each item of the ICARO score. We then computed the score for each patient, and performed a receiver operating characteristic (ROC) curve analysis. In univariate analysis, none of the ICARO items were significantly different given the presence of a concomitant DVT. Given computed scores, 55 patients (45.1%) had a low risk, 17 (13.9%) had an intermediate risk and 50 (41.0%) had a high risk of a concomitant DVT. The area under the ROC curve was 0.386 [95% CI, 0.268–0.504]. When risk levels were dichotomized as low vs intermediate-high risk, the ICARO score had a sensitivity of 36.0%, a specificity of 40.2%, a positive predictive value of 13.4% and a negative predictive value of 70.9%. Our study does not confirm the utility of the ICARO clinical score to rule out concomitant DVT in case of SVT.


Venous thrombosis Saphenous vein Pulmonary embolism Ultrasonography Risk factors 



We thank Jennifer Hasselgard-Rowe for her editorial advice.

Author contributions

PF, QB and LB served on the steering committee which designed the study and had final responsibility for study supervision and data analysis. PF, QB, BS, HD and LB participated in the STEPH study coordination, data collection and/or the administrative, technical, or logistic support. PF performed statistical analysis of the data. Each author made substantial contribution to data interpretation. PF and LB wrote the first draft of the manuscript. Each author critically reviewed and participated in revising the manuscript, and each author approved the final version.


The STEPH study was supported by a grant from the French Ministry of Health and Sports (Programme Hospitalier de Recherche Clinique 2011).

Compliance with ethical standards

Conflict of interest

Paul Frappé, Quentin Brosse, Laurent Bertoletti and Benjamin Seffert declare that they have no conflict of interest. Hervé Décousus reports personal fees from ASPEN, personal fees from Pfizer/BMS, personal fees from Daiichi-Sankyo Pharma, personal fees from Bayer, grants from Daiichi-Sankyo Pharma and grants from Bayer, outside of the submitted work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Decousus H, Quéré I, Presles E, Becker F, Barrellier M-T, Chanut M, Gillet J-L, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz A (2010) Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med 152(4):218–224CrossRefPubMedGoogle Scholar
  2. 2.
    Frappé P, Buchmuller-Cordier A, Bertoletti L, Bonithon-Kopp C, Couzan S, Lafond P, Leizorovicz A, Merah A, Presles E, Preynat P, Tardy B, Décousus H, STEPH Study Group (2014) Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community-based study. J Thromb Haemost 12(6):831–838CrossRefPubMedGoogle Scholar
  3. 3.
    Galanaud J-P, Genty C, Sevestre M-A, Brisot D, Lausecker M, Gillet J-L, Rolland C, Righini M, Leftheriotis G, Bosson J-L, Quere I (2011) Predictive factors for concurrent deep-vein thrombosis and symptomatic venous thromboembolic recurrence in case of superficial venous thrombosis. The OPTIMEV study. Thromb Haemost 105(1):31–39CrossRefPubMedGoogle Scholar
  4. 4.
    Bauersachs RM (2013) Diagnosis and treatment of superficial vein thrombosis. Hämostaseologie 33(3):232–240CrossRefPubMedGoogle Scholar
  5. 5.
    Hirmerova J, Seidlerova J, Subrt I (2013) Deep vein thrombosis and/or pulmonary embolism concurrent with superficial vein thrombosis of the legs: cross-sectional single center study of prevalence and risk factors. Int Angiol 32(4):410–416PubMedGoogle Scholar
  6. 6.
    Sobreira ML, Maffei FHDA, Yoshida WB, Rollo HA, Lastória S, Griva BL, De Carvalho LR (2009) Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases. Int Angiol J Int Union Angiol 28(5):400–408Google Scholar
  7. 7.
    Cosmi B (2015) Management of superficial vein thrombosis. J Thromb Haemost 13(7):1175–1183CrossRefPubMedGoogle Scholar
  8. 8.
    Pomero F, Di Minno MND, Tamburini Premunian E, Malato A, Pasca S, Barillari G, Fenoglio L, Siragusa S, Di Minno G, Ageno W, Dentali F (2015) A clinical score to rule out the concomitant presence of deep vein thrombosis in patients presenting with superficial vein thrombosis: the ICARO study. Thromb Res 136(5):938–942CrossRefPubMedGoogle Scholar
  9. 9.
    Décousus H, Bertoletti L, Frappé P (2015) Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat? J Thromb Haemost 13(S1):S230–S237CrossRefPubMedGoogle Scholar
  10. 10.
    Décousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G (2010) Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 363(13):1222–1232CrossRefPubMedGoogle Scholar
  11. 11.
    Di Nisio M, Wichers IM, Middeldorp S (2013) Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 4:CD004982Google Scholar
  12. 12.
    Delavenne X, Frappé P, Zufferey P, Mismetti P, Laporte S, Bertoletti L (2014) PK evaluation of fondaparinux sodium for the treatment of thrombosis. Expert Opin Drug Metab Toxicol 10(2):269–277CrossRefPubMedGoogle Scholar
  13. 13.
    Quéré I, Leizorovicz A, Galanaud J-P, Presles E, Barrellier M-T, Becker F, Desprairies G, Guenneguez H, Mismetti P, Décousus H, Prospective Observational Superficial Thrombophlebitis (POST) Study Investigators (2012) Superficial venous thrombosis and compression ultrasound imaging. J Vasc Surg 56(4):1032–1038.e1CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General PracticeUniversity of Saint-EtienneSaint-EtienneFrance
  2. 2.Sainbiose DVHInserm U 1059, University of Saint-EtienneSaint-EtienneFrance
  3. 3.CIC-EC 1408Saint-EtienneFrance
  4. 4.Primary Care UnitUniversity of GenevaGenevaSwitzerland
  5. 5.Department of Vascular Medicine and TherapeuticsCHU de Saint-EtienneSaint-EtienneFrance
  6. 6.Department of General PracticeFaculty of Medicine Jacques LisfrancSaint Priest en JarezFrance

Personalised recommendations