We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
A Randomized Trial of Diagnostic Strategies after Normal Proximal Vein Ultrasonography for Suspected Deep Venous Thrombosis: D-Dimer Testing Compared with Repeated Ultrasonography.
- Authors
Kearon, Clive; Ginsberg, Jeffrey S.; Douketis, James; Crowther, Mark A.; Turpie, Alexander G.; Bates, Shannon M.; Lee, Agnes; Brill-Edwards, Patrick; Finch, Terri; Gent, Michael
- Abstract
Background: With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative D-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. Objective: To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. Design: Randomized, multicenter trial. Setting: Four university hospitals. Patients: 810 outpatients with suspected deep venous thrombosis and negative results on proximal vein ultrasonography. Interventions: Erythrocyte agglutination D-dimer testing followed by no further testing if the result was negative and venography if the result was positive (experimental) or ultrasonography repeated after 1 week in all patients (control). Measurements: Symptomatic deep venous thrombosis diagnosed initially and symptomatic venous thromboembolism during 6 months of follow-up. Results: Nineteen of 408 patients (4.7%) in the D-dimer group and 3 of 402 patients (0.7%) in the repeated ultrasonography group initially received a diagnosis of deep venous thrombosis (P < 0.001). During follow-up of patients without a diagnosis of deep venous thrombosis on initial testing, 8 patients (2.1% [95% CI, 0.9% to 4.0%]) in the D-dimer group and 5 patients (1.3% [CI, 0.4% to 2.9%]) in the repeated ultrasonography group developed symptomatic venous thromboembolism (difference, 0.8 percentage point [CI, - 1.1 to 2.9 percentage points]; P > 0.2). Venous thromboembolism occurred in 1.0% (CI, 0.2% to 2.8%) of those with a negative D-dimer result. Limitations: Seventy patients (8.6%) deviated from the diagnostic protocols, and 9 patients (1.1%) had inadequate follow-up. Conclusion: In outpatients with suspected deep venous thrombosis who initially had normal results on ultrasonography of the proximal veins, a strategy based on D-dimer testing followed by no further testing if the result was negative and venography if the result was positive had acceptable safety and did not differ from the safety of a strategy based on withholding anticoagulant therapy and routinely repeating ultrasonography after 1 week.
- Subjects
ULTRASONIC imaging; THROMBOSIS; BLOOD coagulation; CARDIOVASCULAR diseases; BLOOD vessels; PROTEIN S deficiency
- Publication
Annals of Internal Medicine, 2005, Vol 142, Issue 7, p490
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-142-7-200504050-00007