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Systematic review
A low Wells score and a negative D-dimer was not safe in patients with cancer for ruling out DVT
  1. Alfonso Tafur
  1. Department of Medicine, Internal Medicine-Cardiovascular, Oklahoma University Health and Science Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to : Dr Alfonso Tafur, Department of Medicine, Internal Medicine-Cardiovascular, Oklahoma University Health and Science Center, Oklahoma City, OK 73013, USA; alfonso-tafur{at}ouhsc.edu

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Context

In combination with a D-dimer serum test, the Wells rule has long been used and recommended to help clinicians discern the likelihood of lower extremity deep vein thrombosis (DVT).1 The safety and efficacy of these tools have been challenged in their applications to populations with distinct incidences of DVT.2 Specifically, patients with a prior DVT and those with malignancy have a high rate of venous thromboembolism (VTE) which may foreseeably decrease the negative predictive value of prediction rules. These specific populations have not been well represented in individual studies.

Methods

For the current study, Geersing et al3 performed a patient-level meta-analysis by combining data extracted from 13 studies published after 2006. The inclusion criteria were restricted to those studies with data on all the predictors of the Wells rule, and D-dimer before the reference test. The accepted reference tests for proximal DVT were compression ultrasound or venography, but if these were absent an uneventful follow-up for 3 months was an acceptable reference for a negative study. When generating …

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