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The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis.
Arch Intern Med. 1997 May 26; 157(10):1077-81.AI

Abstract

OBJECTIVE

To prospectively test the hypothesis that a diagnosis of deep vein thrombosis can be excluded in outpatients who present with clinical indications of deep vein thrombosis and whose results of D-dimer testing and impedance plethysmographic examination on the day of presentation are normal.

DESIGN

Prospective cohort study.

SETTING

Four university-affiliated hospitals.

METHODS

Three hundred ninety-eight consecutive patients with clinical indications of deep vein thrombosis were included in the final analysis. All patients underwent an assessment of pretest probability, bedside D-dimer testing, and impedance plethysmographic examination. In most patients, if the results of D-dimer testing and impedance plethysmographic examination were negative for deep vein thrombosis, anticoagulants were withheld and patients were followed up for 3 months. If the results of one or both tests were abnormal, an examination using venous compression ultrasonography or phlebography was performed.

RESULTS

In the majority of patients (69%), the results of D-dimer testing and impedance plethysmographic examination were normal. This combination had a negative predictive value of 98.5% (95% confidence interval, 96.3-99.6) for deep vein thrombosis.

CONCLUSION

The results of the D-dimer assay and impedance plethysmographic examination on the day of presentation can be used to treat the majority of outpatients who present with clinical indications of deep vein thrombosis without further testing.

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Authors+Show Affiliations

Ginsberg JS
Department of Medicine, McMaster University, Hamilton, Ontario.
Kearon C
No affiliation info available
Douketis J
No affiliation info available
Turpie AG
No affiliation info available
Brill-Edwards P
No affiliation info available
Stevens P
No affiliation info available
Panju A
No affiliation info available
Patel A
No affiliation info available
Crowther M
No affiliation info available
Andrew M
No affiliation info available
Massicotte P
No affiliation info available
Hirsh J
No affiliation info available
Weitz JI
No affiliation info available

MeSH

AdultAgedAged, 80 and overAmbulatory CareAnticoagulantsAntifibrinolytic AgentsCohort StudiesConfidence IntervalsDiagnosis, DifferentialFemaleFibrin Fibrinogen Degradation ProductsFollow-Up StudiesHumansMaleMiddle AgedOutcome Assessment, Health CarePhlebographyPlethysmography, ImpedancePredictive Value of TestsProbabilityProspective StudiesThrombophlebitisUltrasonography

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9164373

Citation

Ginsberg, J S., et al. "The Use of D-dimer Testing and Impedance Plethysmographic Examination in Patients With Clinical Indications of Deep Vein Thrombosis." Archives of Internal Medicine, vol. 157, no. 10, 1997, pp. 1077-81.
Ginsberg JS, Kearon C, Douketis J, et al. The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis. Arch Intern Med. 1997;157(10):1077-81.
Ginsberg, J. S., Kearon, C., Douketis, J., Turpie, A. G., Brill-Edwards, P., Stevens, P., Panju, A., Patel, A., Crowther, M., Andrew, M., Massicotte, P., Hirsh, J., & Weitz, J. I. (1997). The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis. Archives of Internal Medicine, 157(10), 1077-81.
Ginsberg JS, et al. The Use of D-dimer Testing and Impedance Plethysmographic Examination in Patients With Clinical Indications of Deep Vein Thrombosis. Arch Intern Med. 1997 May 26;157(10):1077-81. PubMed PMID: 9164373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis. AU - Ginsberg,J S, AU - Kearon,C, AU - Douketis,J, AU - Turpie,A G, AU - Brill-Edwards,P, AU - Stevens,P, AU - Panju,A, AU - Patel,A, AU - Crowther,M, AU - Andrew,M, AU - Massicotte,P, AU - Hirsh,J, AU - Weitz,J I, PY - 1997/5/26/pubmed PY - 1997/5/26/medline PY - 1997/5/26/entrez SP - 1077 EP - 81 JF - Archives of internal medicine JO - Arch Intern Med VL - 157 IS - 10 N2 - OBJECTIVE: To prospectively test the hypothesis that a diagnosis of deep vein thrombosis can be excluded in outpatients who present with clinical indications of deep vein thrombosis and whose results of D-dimer testing and impedance plethysmographic examination on the day of presentation are normal. DESIGN: Prospective cohort study. SETTING: Four university-affiliated hospitals. METHODS: Three hundred ninety-eight consecutive patients with clinical indications of deep vein thrombosis were included in the final analysis. All patients underwent an assessment of pretest probability, bedside D-dimer testing, and impedance plethysmographic examination. In most patients, if the results of D-dimer testing and impedance plethysmographic examination were negative for deep vein thrombosis, anticoagulants were withheld and patients were followed up for 3 months. If the results of one or both tests were abnormal, an examination using venous compression ultrasonography or phlebography was performed. RESULTS: In the majority of patients (69%), the results of D-dimer testing and impedance plethysmographic examination were normal. This combination had a negative predictive value of 98.5% (95% confidence interval, 96.3-99.6) for deep vein thrombosis. CONCLUSION: The results of the D-dimer assay and impedance plethysmographic examination on the day of presentation can be used to treat the majority of outpatients who present with clinical indications of deep vein thrombosis without further testing. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/9164373/The_use_of_D_dimer_testing_and_impedance_plethysmographic_examination_in_patients_with_clinical_indications_of_deep_vein_thrombosis_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/157/pg/1077 DB - PRIME DP - Unbound Medicine ER -