Management of suspected deep venous thrombosis in outpatients by using clinical assessment and D-dimer testing.

Abstract:

BACKGROUND:When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis. OBJECTIVE:To determine whether the combination of a low clinical suspicion and a normal D -dimer result rules out deep venous thrombosis. DESIGN:Prospective cohort study. SETTING:Three tertiary care hospitals in Canada. PATIENTS:445 outpatients with a suspected first episode of deep venous thrombosis. INTERVENTIONS:Patients were categorized as having low, moderate, or high pretest probability of thrombosis and underwent whole-blood D -dimer testing. Patients with a low pretest probability and a negative result on the D -dimer test had no further diagnostic testing and received no anticoagulant therapy. Additional diagnostic testing was done in all other patients. MEASUREMENTS:Venous thromboembolic events during 3-month follow-up. RESULTS:177 (40%) patients had both a low pretest probability and a negative D -dimer result. One of these patients had deep venous thrombosis during follow-up (negative predictive value, 99.4% [95% CI, 96.9% to 100%]). CONCLUSION:The combination of a low pretest probability of deep venous thrombosis and a negative result on a whole-blood D -dimer test rules out deep venous thrombosis in a large proportion of symptomatic outpatients.

journal_name

Ann Intern Med

authors

Kearon C,Ginsberg JS,Douketis J,Crowther M,Brill-Edwards P,Weitz JI,Hirsh J

doi

10.7326/0003-4819-135-2-200107170-00011

subject

Has Abstract

pub_date

2001-07-17 00:00:00

pages

108-11

issue

2

eissn

0003-4819

issn

1539-3704

pii

200107170-00011

journal_volume

135

pub_type

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