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Bates, S.M. et al.

Bates, Kearon, Crowther, Linkins, O'Donnell, Douketis, Lee, Weitz, Johnston, Ginsberg,

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

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.[1]

References

A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis. Bates, S.M., Kearon, C., Crowther, M., Linkins, L., O'Donnell, M., Douketis, J., Lee, A.Y., Weitz, J.I., Johnston, M., Ginsberg, J.S. Ann. Intern. Med. (2003) [Pubmed]

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