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Ann Intern Med. 2003 May 20;138(10):787-94.

A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis.

Author information

  • 1McMaster University Medical Centre, HSC 3W11, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. batesm@mcmaster.ca

Abstract

BACKGROUND:

Because clinical diagnosis is inaccurate, objective testing is usually considered necessary when patients present with suspected deep venous thrombosis (DVT).

OBJECTIVE:

To determine whether a negative result on a quantitative latex D dimer assay eliminates the need for further investigation in patients with a low or moderate pretest probability of DVT.

DESIGN:

Prospective cohort study.

SETTING:

Three tertiary care hospitals in Canada.

PATIENTS:

556 consecutive outpatients with suspected first DVT.

INTERVENTION:

Patients were categorized as having a low, moderate, or high pretest probability of DVT and then underwent D-dimer testing. Patients with low or moderate pretest probability and a negative D-dimer result had no further diagnostic testing and received no anticoagulant therapy. Serial compression ultrasonography was performed in all other patients. Patients who did not receive a diagnosis of DVT were followed for symptomatic venous thromboembolism.

MEASUREMENTS:

Objectively confirmed symptomatic venous thromboembolic events during 3 months of follow-up.

RESULTS:

283 patients (51%) had low or moderate pretest probability and a negative D-dimer result. One of these patients had DVT during follow-up (negative likelihood ratio, 0.05 [CI, 0.01 to 0.23]). The negative likelihood ratio of the d -dimer test in all patients was 0.03 (CI, 0.01 to 0.16).

CONCLUSION:

A negative result on a quantitative latex d -dimer assay safely eliminates the need for further testing in patients with low or moderate pretest probability of DVT.

PMID:
12755550
[PubMed - indexed for MEDLINE]
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