title: Exclusion of first-episode deep-vein thrombosis after-hours using D-dimer.
abstract: The objective of this study was to test the safety of withholding anticoagulant treatment and additional call-back diagnostic testing with ultrasound in patients who have a negative D-dimer at presentation. Patients with signs and symptoms of deep-vein thrombosis who presented to the emergency department after regular hours and on weekends underwent D-dimer testing using the STA-Liatest D-di. In patients with negative D-dimer results, heparin therapy was withheld, and no further diagnostic testing for deep-vein thrombosis was done as part of the initial evaluation. Patients with positive D-dimer results underwent compression ultrasonography. The primary outcome measure was a diagnosis of new symptomatic venous thromboembolism confirmed by diagnostic testing during the 3-month follow-up period. Of the 260 eligible patients, 81 (31%) had a negative D-dimer and 179 (69%) had a positive D-dimer. No patient with a negative D-dimer at presentation had confirmed venous thromboembolism at 3-month follow-up. Three patients died: one by intracranial hemorrhage secondary to cerebrovascular accident; and two deaths of indeterminate cause almost 3 months after entry. The automated assay for D-dimer, the STA-Liatest D-di, seems to provide a simple method with high clinical utility for excluding acute first-episode deep-vein thrombosis in symptomatic patients who present to the emergency room after regular hours.
authors.affiliation: Cardiovascular Section, Department of Medicine, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. suman-rathbun@ouhsc.edu
authors.forename: Suman W
authors.initials: SW
authors.lastname: Rathbun
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Whitsett
authors.forename: Gary E
authors.initials: GE
authors.lastname: Raskob
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001780:Blood Coagulation Tests / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D054556:Venous Thromboembolism / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D