Marc Righini, MD; Henri Bounameaux, MD; Grégoire Le Gal, MD
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Righini M., Bounameaux H., Le Gal G.; Single Complete Compression Ultrasonography for Suspected Deep Venous Thrombosis: Ideal in Routine Clinical Practice?. Ann Intern Med. 2004;141:888-889. doi: 10.7326/0003-4819-141-11-200412070-00017
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Published: Ann Intern Med. 2004;141(11):888-889.
TO THE EDITOR:
Stevens and colleagues (1) reported that single complete lower-limb compression ultrasonography (that is, including the calf veins) is safe for excluding deep venous thrombosis (DVT). It is interesting to note that previous studies using proximal (that is, not studying the calf veins), serial (2, 3), or single proximal compression ultrasonography associated with clinical probability and d-dimer tests (4) showed similar low 3-month thromboembolic risks. Using a single ultrasonographic examination without clinical probability assessment or d-dimer dosage may be very practical in an outpatient setting. However, even if this kind of strategy has the great advantage of avoiding repeated compression ultrasonography, it requires that ultrasonography be performed in every patient. This may not be particularly cost-effective. D-Dimer measurement may rule out DVT without further testing in a substantial proportion of outpatients (30%), a strategy that is highly cost-effective (5).
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