Key result
Low pretest probability plus negative D-dimer safely excludes VTE, particularly in younger, comorbidity-free outpatients.
Why the study?
Accurate and timely diagnosis of venous thromboembolism is challenging due to its variable presentation, necessitating clarification of the roles of clinical prediction rules and D-dimer testing in practice.
Supports D-dimer testing to exclude VTE in select low-risk outpatients; leaves open validation in older or comorbid populations.
Venous thromboembolism (VTE) is extraordinarily common and is a major cause of morbidity and mortality. However, accurate and timely diagnosis of VTE is confounded by its kaleidoscopic presentation. Clinical prediction rules (CPRs) and D-dimer testing have both been increasingly employed to clarify the complex decision making required in such cases. Formal clinical pretest probability now serves as the root of algorithms for the diagnosis of DVT and PE. A low pretest probability of VTE plus a negative D dimer can be combined in a bayesian fashion to effectively exclude the diagnosis of VTE. The evidence for this strategy is strongest in younger outpatients with no associated comorbidities, no prior history of VTE, and a short duration of symptoms.
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Hargett et al. (2008) conducted a review in Venous thromboembolism (VTE). Clinical prediction rules and D-dimer testing was evaluated. A low clinical pretest probability combined with a negative D-dimer test can effectively exclude the diagnosis of venous thromboembolism, particularly in younger outpatients without comorbidities.
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