Clinical value of simple proximal vein ultrasonography plus D-dimer vs whole-leg colour
doppler ultrasonography for the diagnosis of deep vein thrombosis
Evidence summaries
Editors
24.2.2009
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.
In a prospective, multi-centre trial «Bernardi E, Camporese G, Büller HR, Siragusa S, Im...»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
- Bernardi E, Camporese G, Büller HR, Siragusa S, Imberti D, Berchio A, Ghirarduzzi
A, Verlato F, Anastasio R, Prati C, Piccioli A, Pesavento R, Bova C, Maltempi P, Zanatta
N, Cogo A, Cappelli R, Bucherini E, Cuppini S, Noventa F, Prandoni P, Erasmus Study
Group. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler
ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized
controlled trial. JAMA 2008 Oct 8;300(14):1653-9. «PMID: 18840838»PubMed.
Article ID: evd06312
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