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d-dimer in the Diagnosis of DVT -- A Randomized Trial

Summary and Comment |
October 14, 2003

d-dimer in the Diagnosis of DVT -- A Randomized Trial

  1. Allan S. Brett, MD

D-dimer testing and clinical risk assessment could reduce the number of ultrasounds that are performed for suspected DVT.

  1. Allan S. Brett, MD

Although several diagnostic strategies have been proposed for deep-vein thrombosis (DVT), they have not been compared in randomized trials. Now, Canadian investigators report results of a multicenter trial that involved 1096 outpatients with suspected DVT.

First, clinicians determined whether each patient's pretest probability of DVT was high or low, according to a previously validated prediction model. Then, patients were randomized to either d-dimer testing or no d-dimer testing (controls). In the d-dimer group, patients with low clinical probabilities and negative d-dimer tests underwent no further work-up, and the remaining patients underwent ultrasonography. In the control group, all patients underwent ultrasonography. In both groups, high-risk patients with negative ultrasound results underwent repeat ultrasonography at 1 week.

During the initial evaluation, DVT was diagnosed in about 15% of patients in each group. During 3 months of follow-up, 2 additional venous thromboembolic events occurred in the d-dimer group, and 6 occurred in the control group -- a nonsignificant difference. Ultrasound was not performed in 39% of d-dimer patients.

Comment

  1. Allan S. Brett, MD

In this trial, a diagnostic strategy that involved d-dimer testing and selective ultrasonography performed as well as a strategy of mandatory ultrasonography for all patients. The success of the d-dimer strategy elsewhere will depend on at least 2 things -- the ability of clinicians to apply correctly the pretest probability model, and the accuracy of a given d-dimer assay (in this study, the SimpliRED assay and IL-Test were used).

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