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

http://dx.doi.org/10.1136/ebm.10.6.179

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    Kearon C, Ginsberg JS, Douketis J, et al. A randomized trial of diagnostic strategies after normal proximal vein ultrasonography for suspected deep venous thrombosis: D-dimer testing compared with repeated ultrasonography. Ann Intern Med 2005;142:490–6.
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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 ★★★★★★☆

    METHODS

    Embedded ImageDesign:

    randomised controlled trial.

    Embedded ImageAllocation:

    concealed.*

    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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    Footnotes

    • ↵* 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.