A new diagnostic rule for deep vein thrombosis: safety and efficiency in clinically relevant subgroups

Abstract

The rule can safely exclude DVT in primary care patients suspected of DVT, irrespective of age, gender and history of DVT.

D-dimer testing in elderly patients in primary care for exclusion of venous thromboembolism

“…As Carrier et al also found, we concluded that a low risk according to the clinical decision rule in combination with a negative D-dimer result can effectively exclude DVT in the elderly. Interestingly, in contrast to the study of Carrier et al in the elderly hospital outpatients, but in accordance with other studies [11,12], we found a higher prevalence of DVT in the older age groups: The prevalence of DVT in our study ranged from 16.7% (aged < 50 years) to 21.7% (aged ‡ 70 years; Table 1) [6]. To improve the rulesÕ efficiency in the oldest age group ( ‡ 70 years), we proposed to redefine the cut-off values of the D-dimer to 1000 ng L )1…”

“…In a similar study in the primary care setting, published a few months earlier, we obtained similar results and drew similar conclusions for this setting [6]. That study included 2086 consecutive primary care patients suspected of having DVT selected from 110 physicians in The Netherlands.…”

“…The use of clinical decision rules and D-dimer testing of patients suspected of having DVT and PE has been shown to improve the diagnosis of DVT and PE [4][5][6][7][8]. All developed clinical decision rules need to be validated before they can be safely used in practice [9,10], especially when they are to be used in subjects not well represented in the studies that led to the develeopment of such decision rules.…”

“…As a result, the proportion of patients in whom DVT could be excluded increased from 9.8% to 33.8% at the cost of only 1.4% instead of 0.7% missed cases in the very low risk category [6]. Now, two studies, Carrier et al [1] and Toll et al [6], share the view that the ruling out of DVT using clinical decision rules and D-dimer testing is also feasible in elderly patients, in primary and secondary care.…”

“…Now, two studies, Carrier et al [1] and Toll et al [6], share the view that the ruling out of DVT using clinical decision rules and D-dimer testing is also feasible in elderly patients, in primary and secondary care. Together with Carrier, we support the call for prospective validation of clinical decision rules with different D-dimer assays in elderly patients, in all healthcare settings.…”