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D-dimer testing reduced the need for ultrasonographic imaging in outpatients with suspected deep venous thrombosis

Clinical impact ratings GP/FP/Primary care IM/Ambulatory care Haematology

Key Words: fibrin fibrinogen degradation products • venous thrombosis

The first 150 words of the full text of this article appear below.

METHODS
Design: randomised controlled trial.

Allocation: concealed.^*

Blinding: blinded (ultrasonographers, technicians who measured D-dimer concentrations, and outcome assessors).^*

Follow up period: 3 months.

Setting: Thrombosis units and emergency departments of 5 academic health centres in Canada.

Patients: 1096 outpatients (mean age 58 y, 58% women) who had suspected lower extremity DVT. Exclusion criteria included refusal or inability to consent and geographic inaccessibility.

Intervention: patients were stratified by the application of a clinical model as "likely" or "unlikely" to have DVT and were subsequently allocated to D-dimer testing (n = 566) or VUI alone (n = 530). Patients in the D-dimer group received VUI if they were "likely" to have DVT or if they were "unlikely" to have DVT but the D-dimer test result was positive. Patients who were "unlikely" to have DVT and whose D-dimer test result was negative did not receive VUI. Patients in the VUI alone group who were . . . [Full text of this article]

Jodi B Segal, MD, MPH

Johns Hopkins University School of Medicine
Baltimore, Maryland, USA