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Safety of a D-dimer based strategy and repeated ultrasonography did not differ in DVT and normal proximal vein ultrasonography

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 Q In patients with suspected deep venous thrombosis (DVT) and negative results on proximal vein ultrasonography, how does a D-dimer–based management strategy that minimises additional assessments compare with routine repeated ultrasonography?

Clinical impact ratings IM/Ambulatory care ★★★★★★☆ Emergency medicine ★★★★★☆☆ Haematology ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (outcome assessors).*

Embedded ImageFollow up period:

6 months.

Embedded ImageSetting:

thrombosis services of 4 university hospitals in Hamilton, Ontario, Canada.

Embedded ImagePatients:

810 patients (mean age 59.5 y, 62% women) with a suspected first episode of DVT and negative results on proximal vein ultrasonography who were referred by primary care and hospital-based physicians to a thrombosis outpatient service. Exclusion criteria included life expectancy <6 months, contraindication to venography, use of full dose heparin for >48 hours, use of long term warfarin therapy, symptoms of pulmonary embolism, and …

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  • * See glossary.

  • For correspondence: Dr C Kearon, McMaster University and the Henderson Research Centre, Hamilton, Ontario, Canada

  • Sources of funding: National Health Research Development Program of Health Canada; Heart and Stroke Foundation of Canada; Canadian Institutes of Health Research.