Clinical Pretest Probability & D-dimer Combo Help Diagnose DVT Effectively
Clinical evaluation, D-dimer blood testing, and ultrasound imaging are widely used in the evaluation of suspected deep vein thrombosis (DVT) of the lower extremities. A recent study suggests that a diagnostic strategy using a combination of clinical pretest probability and D-dimer helps to identify patients at low risk for DVT. The study findings were published in the BMJ on February 15, 2022.
When DVT is suspected, diagnostic testing often starts with an assessment of clinical pretest probability. DVT is considered excluded if clinical pretest probability is low and the D-dimer test is negative. In a previous analysis, Dr Clive Kearon and her team showed that the use of pretest probability specific cut-off points for D-dimer excluded DVT in a greater proportion of patients than the use of a single cut-off point, without sacrificing negative predictive value. To further explore, the research team conducted and evaluated the safety and efficiency of a diagnostic algorithm for DVT that uses clinical pretest probability based D-dimer thresholds to exclude DVT.
In a prospective diagnostic management study, the researchers included 1508 patients with symptoms or signs of DVT. The researchers performed proximal ultrasound imaging in eligible patients. They restricted repeated proximal ultrasonography to patients with initially negative ultrasonography, low or moderate clinical pretest probability, and D-dimer >3000 ng/mL or high clinical pretest probability and D-dimer >1500 ng/mL. Patients did not receive anticoagulant treatment if DVT was not diagnosed. The major outcome assessed was symptomatic venous thromboembolism at three months.
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