Document Detail


A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis.
MedLine Citation:
PMID:  12755550     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Because clinical diagnosis is inaccurate, objective testing is usually considered necessary when patients present with suspected deep venous thrombosis (DVT). OBJECTIVE: To determine whether a negative result on a quantitative latex D dimer assay eliminates the need for further investigation in patients with a low or moderate pretest probability of DVT. DESIGN: Prospective cohort study. SETTING: Three tertiary care hospitals in Canada. PATIENTS: 556 consecutive outpatients with suspected first DVT. INTERVENTION: Patients were categorized as having a low, moderate, or high pretest probability of DVT and then underwent D-dimer testing. Patients with low or moderate pretest probability and a negative D-dimer result had no further diagnostic testing and received no anticoagulant therapy. Serial compression ultrasonography was performed in all other patients. Patients who did not receive a diagnosis of DVT were followed for symptomatic venous thromboembolism. MEASUREMENTS: Objectively confirmed symptomatic venous thromboembolic events during 3 months of follow-up. RESULTS: 283 patients (51%) had low or moderate pretest probability and a negative D-dimer result. One of these patients had DVT during follow-up (negative likelihood ratio, 0.05 [CI, 0.01 to 0.23]). The negative likelihood ratio of the d -dimer test in all patients was 0.03 (CI, 0.01 to 0.16). CONCLUSION: A negative result on a quantitative latex d -dimer assay safely eliminates the need for further testing in patients with low or moderate pretest probability of DVT.
Authors:
Shannon M Bates; Clive Kearon; Mark Crowther; Lori Linkins; Martin O'Donnell; Jim Douketis; Agnes Y Y Lee; Jeffrey I Weitz; Marilyn Johnston; Jeffrey S Ginsberg
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  138     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-20     Completed Date:  2003-06-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-94     Citation Subset:  AIM; IM    
Affiliation:
McMaster University Medical Centre, HSC 3W11, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. batesm@mcmaster.ca
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Fibrin Fibrinogen Degradation Products / diagnostic use*
Humans
Latex Fixation Tests / methods*
Predictive Value of Tests
Prospective Studies
Risk Factors
Venous Thrombosis / diagnosis*,  ultrasonography
Chemical
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Evidence for use of coronary stents. A hierarchical bayesian meta-analysis.
Next Document:  The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthrit...