Suman W. Rathbun, MD, MS; Thomas L. Whitsett, MD; Gary E. Raskob, PhD
Acknowledgments: The authors thank Kevin Dahlin, Kyle Enfield, Janette Epperly, Jay Heath, Brenda Holliefield, Cindy Jones, Peggy Powell, and Penny Razo-Mosier for their assistance with this project.
Grant Support: By an Oklahoma Center for the Advancement of Science and Technology (OCAST) Health Research Grant (HR0-052) and in part by a National Institutes of Health, National Heart, Lung, and Blood Institute Research Career Training Award (K23) (HL04200-03). STA-Liatest d-dimer reagents were provided by Diagnostica Stago.
Potential Financial Conflicts of Interest:Grants received: S.W. Rathbun (Diagnostica Stago); Other: S.W. Rathbun (reagents for d-dimer were provided by Diagnostica Stago).
Requests for Single Reprints: Suman W. Rathbun, MD, Department of Medicine, WP 3120, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Oklahoma City, OK 73104; e-mail, email@example.com.
Current Author Addresses: Drs. Rathbun and Whitsett: Department of Medicine, WP 3120, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Oklahoma City, OK 73104.
Dr. Raskob: University of Oklahoma Health Sciences Center, College of Public Health, 801 Northeast 13th Street, Room 139, Oklahoma City, OK 73104.
Author Contributions: Conception and design: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Analysis and interpretation of the data: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Drafting of the article: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Critical revision of the article for important intellectual content: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Final approval of the article: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Provision of study materials or patients: S.W. Rathbun, T.L. Whitsett.
Statistical expertise: G.E. Raskob.
Obtaining of funding: S.W. Rathbun.
Administrative, technical, or logistic support: S.W. Rathbun.
Collection and assembly of data: S.W. Rathbun, T.L. Whitsett, G.E. Raskob.
Rathbun SW, Whitsett TL, Raskob GE. Negative d-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial. Ann Intern Med. 2004;141:839-845. doi: 10.7326/0003-4819-141-11-200412070-00007
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Published: Ann Intern Med. 2004;141(11):839-845.
Acute recurrent deep venous thrombosis (DVT) is often difficult to differentiate from post-thrombotic syndrome, and each of the established diagnostic methods has limitations. A reliable test that excludes the diagnosis would be clinically useful.
Patients with suspected recurrent DVT underwent d-dimer testing. Heparin was withheld or withdrawn in patients with negative results, and no additional testing was performed, regardless of symptoms. Three-month follow-up showed a low incidence (0.75% [95% CI, 0.02% to 4.09%]) of confirmed DVT in patients with a negative d-dimer result.
d-dimer testing may obviate the need to perform additional testing in up to two thirds of patients being evaluated for recurrent DVT.
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