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Ann Intern Med. 2001 Jul 17;135(2):108-11.

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

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McMaster University Clinic, Room 401, Henderson General Hospital, 711 Concession Street; Hamilton, Ontario L8V 1C3, Canada.



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.

[Indexed for MEDLINE]

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