title: [Exclusion of deep-vein thrombosis and pulmonary embolism using clinical decision rules and D-dimer tests].
abstract: Clinical diagnosis of a venous thromboembolism (VTE) is often difficult because the symptoms of this disorder are diverse and unspecified. The combination of a low probability clinical decision rule and an unremarkable D-dimer test is a safe way to exclude the presence of a VTE. Clinical decision rules for the diagnosis of a deep-vein thrombosis are available for primary and secondary care and clinical decision rules for the diagnosis of a pulmonary embolism is available for secondary care. Various D-dimer tests are available that differ with regard to sensitivity, specificity and duration of the measurement. During pregnancy and puerperium using a clinical decision rule and a D-dimer test is inadequate: additional radiologic investigation is always indicated in this situation. The diagnostic value of the D-dimer test during suspected recurrence of a VTE is yet to be determined.
authors.affiliation: Leids Universitair Medisch Centrum, afd. Algemene Interne Geneeskunde-Endocrinologie, Leiden, the Netherlands. i.c.m.mos@lumc.nl
authors.forename: Inge C M
authors.initials: IC
authors.lastname: Mos
authors.forename: Melanie
authors.initials: M
authors.lastname: Tan
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards*; D003937:Diagnosis, Differential; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D