The ELISAs in general dominate the comparative ranking among the d-dimer assays for sensitivity and negative likelihood ratio. For excluding PE or DVT, a negative result on quantitative rapid ELISA is as diagnostically useful as a normal lung scan or negative duplex ultrasonography finding.

Low-molecular-weight heparin is at least as effective and as safe as classic intravenous heparin therapy under the conditions of this study and more convenient to administer. The simplified therapy provided by low-molecular-weight heparin may allow patients with uncomplicated proximal deep-vein thrombosis to be cared for in an outpatient setting.

SUMMARY Although it is generally accepted that negative venography excludes deep vein thrombosis (DVT) in patients in whom it is clinically suspected, there is no evidence to support this conclusion. To test the correctness of withholding anticoagulant therapy in these patients, we followed 160 consecutive patients who had clinically suspected DVT and method of Rabinov and Paulin' in two hospitals and by a previously described method8 in the other two. After the procedures were completed, the veins of each leg were flushed with 100 ml of saline. Venography was interpreted as previously described.6 The venographic findings were interpreted independently without knowledge of the clinical findings. In 158 patients, ascending venography showed a well-opacified deep vein system in both legs, and the posterior tibial veins, peroneal veins, the soleal plexus, the popliteal, superficial femoral, common femoral, external and common iliac veins were visualized. Careful attention was given to technique and injection of contrast medium was repeated if inadequate visualization occurred on the first attempt. In two patients, the external and common iliac veins were not adequately visualized by repeat injection and a direct femoral vein puncture was required for successful visualization.The patients were 17-84 years old, mean age 51 years. Sixty-five were males and 95 were females. In all cases, a consulting physician agreed, after examining the patient, that the clinical findings suggested DVT and that this diagnosis could not be confidently ruled out in favor of an alternate diagnosis.The history and physical findings were assessed in a standard fashion and recorded prospectively on the study data forms. The findings recorded included the presence or absence of pain, tenderness, swelling, edema, cord, Homan's sign, and localization of these symptoms and signs to the calf region only, the thigh only, or calf and thigh.In each patient, baseline impedance plethysmography and leg scanning were performed in both legs at the time of venography and repeated at 72 hours. The methods for performing and interpreting impedance plethysmography7 and leg scanning8 have been de-

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