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

C Kearon, J S Ginsberg, J Douketis, M Crowther, P Brill-Edwards, J I Weitz, J Hirsh
Annals of Internal Medicine 2001 July 17, 135 (2): 108-11

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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"