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
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