Algorithms for the diagnosis of deep-vein thrombosis in patients with low clinical pretest probability.
The objective of this current trial was to evaluate the rate of deep-vein thrombosis (DVT) in patients after low clinical risk stratification and to evaluate the value of D-dimer and different imaging techniques in the diagnostic algorithm. A total of 99 consecutive patients were included in this prospective trial. After clinical risk assessment, D-dimer was determined. Final diagnosis was based on the results of duplex sonography, in cases of indeterminate scans on those of ascending venography. Three months after admission, follow-up investigations were performed by a telephone interview to evaluate possible further venous thromboembolism. Final diagnosis was based on the results of colour Doppler ultrasound in 92.9% and on those of venography in 7.1%. DVT was diagnosed in 2%, D-dimer was positive in 48.4%, giving a sensitivity of 100%, a specificity of 52.7% and a negative predictive value of 100%. Follow-up was possible in 89.9%--no further thromboembolic event occurred. In this specific patient group, a negative D-dimer excludes DVT and can therefore reduce the number of imaging procedures by one-half, which, on the contrary, is necessary in patients with positive D-dimer.
Bucek
Robert A
RA
Clinic for Internal Medicine II-Department of Angiology, General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria. robert.bucek@akh-wien.ac.at
Koca
Nihat
N
Reiter
Markus
M
Haumer
Markus
M
Zontsich
Thomas
T
Minar
Erich
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003663:Decision Trees; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D018570:Risk Assessment; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D