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Evidence summaries

Clinical Value of Simple Proximal Vein Ultrasonography Plus D-Dimer Vs Whole-Leg Colour Doppler Ultrasonography for the Diagnosis of Deep Vein Thrombosis

Normal findings in 2-point proximal vein ultrasonography + normal D-dimer test, or normal findings in serial 2-point ultrasonography with abnormal D-dimer test predict a similar low (about 1%) 3-month incidence of symptomatic deep venous thromboembolism as normal findings in whole-leg colour doppler ultrasonography. Level of evidence: "A"

In a prospective, multi-centre trial 1 2098 out of 2465 consequtive symptomatic outpatients with suspected first episode of deep vein thrombosis were randomized to undergo 2-point or whole-leg ultrasonography. Patients who had normal 2-point ultrasonography were tested for D-dimer. Patients with normal D-dimer levels were spared further investigations, whereas those with abnormal D-dimer level were scheduled for a repeat 2-point ultrasonography at 1 week. The 3-month incidence of objectively confirmed symptomatic venous thromboembolism after normal findings in initial workup was 0.9% (7/801), 95% CI 0.3% to 1.8% in the 2-point strategy group and 1.2% (9/763), 95% CI 0.5% to 2.2%) in the whole leg strategy group. Only 4 patients were lost to follow-up.

    References

    • Bernardi E, Camporese G, Büller HR, Siragusa S, Imberti D, Berchio A, Ghirarduzzi A, Verlato F, Anastasio R, Prati C, Piccioli A, Pesavento R, Bova C, Maltempi P, Zanatta N, Cogo A, Cappelli R, Bucherini E, Cuppini S, Noventa F, Prandoni P, Erasmus Study Group. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA 2008 Oct 8;300(14):1653-9. [PubMed].

Primary/Secondary Keywords