Clive Kearon, MB, PhD; Jeffrey S. Ginsberg, MD; James Douketis, MD; Mark Crowther, MD; Patrick Brill-Edwards, MD; Jeffrey I. Weitz, MD; Jack Hirsh, MD
Kearon C, Ginsberg JS, Douketis J, Crowther M, Brill-Edwards P, Weitz JI, et al. Management of Suspected Deep Venous Thrombosis in Outpatients by Using Clinical Assessment and d-dimer Testing. Ann Intern Med. 2001;135:108-111. doi: 10.7326/0003-4819-135-2-200107170-00011
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Published: Ann Intern Med. 2001;135(2):108-111.
When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis.
To determine whether the combination of a low clinical suspicion and a normal d-dimer result rules out deep venous thrombosis.
Prospective cohort study.
Three tertiary care hospitals in Canada.
445 outpatients with a suspected first episode of deep venous thrombosis.
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.
Venous thromboembolic events during 3-month follow-up.
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%]).
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.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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