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

https://doi.org/10.1136/ebm.9.3.89

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    Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003;349:1227–35.
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 Q In outpatients with suspected deep venous thrombosis (DVT), does the use of D-dimer testing safely reduce the need for venous ultrasonographic imaging (VUI) and rule out DVT on the day of presentation?

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

    METHODS

    Embedded ImageDesign:

    randomised controlled trial.

    Embedded ImageAllocation:

    concealed.*

    Embedded ImageBlinding:

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

    Embedded ImageFollow up period:

    3 months.

    Embedded ImageSetting:

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

    Embedded ImagePatients:

    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.

    Embedded ImageIntervention:

    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 …

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    Footnotes

    • ↵* See glossary.

    • For correspondence: Professor P S Wells, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada. pwellsohri.ca

    • Sources of funding: Heart and Stroke Foundation of Ontario and Heart and Stroke Foundation of Nova Scotia, Canada.

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      BMJ Publishing Group Ltd
      BMJ Evidence-Based Medicine 2004; 9 96-96 Published Online First: 28 May 2004. doi: 10.1136/ebm.9.3.96