Safely Ruling Out Deep Venous Thrombosis in Primary Care

Abstract

The Netherlands Organization for Scientific Research.

A Cost-effectiveness Analysis of Diagnostic Algorithms of Deep Vein Thrombosis at the Emergency Department

“…PTP followed by D-dimer safely ruled out DVT in about 30% of patients with a suspected first episode of DVT. As recently shown in a meta-analysis [2], this outcome was consistent with other similar clinical studies. Table 1 shows patients characteristics.…”

“…Clinical studies and meta analyses show that algorithms based upon Pre-Test Probability (PTP) assessment and D-dimer safely rule out venous thromboembolism (VTE) when the PTP for the disease is assessed as low and D-dimer is negative [1][2][3]. By these means DVT is ruled out in 30-50% of outpatients with suspected DVT and safely obviates the need for further diagnostic testing [4,5].…”

“…Suspected cases of deep vein thrombosis (DVT) are common at emergency departments and they often require extensive and costly diagnostic testing [1][2][3]. Clinical studies and meta analyses show that algorithms based upon Pre-Test Probability (PTP) assessment and D-dimer safely rule out venous thromboembolism (VTE) when the PTP for the disease is assessed as low and D-dimer is negative [1][2][3].…”

Near-patient testing holds most promise for acute conditions

“…Point of care D-dimer tests can therefore contribute important information and guide patient management, notably in low risk DVT patients. 4,5 A second example of a near-patient test with immediate consequences for management is the use of point of care C-reactive protein (CRP) testing in lower respiratory tract infections. A recent trial showed a dramatic decrease in antibiotic prescriptions when GPs used CRP testing to guide antibiotic management.…”

The D-Dimer test in combination with a decision rule for ruling out deep vein thrombosis in primary care: diagnostic technology update

“…7 Due to this uncertainty a decision rule specifically for the primary care setting ( Table 1) that includes clinical items and the D-dimer assay result has been developed and validated. 1,8,9 Using this rule, patients in the category of low probability based on the new rule had a 0.7% prevalence of thrombosis. 8 A trial of 1028 patients with suspected DVT using the rule and POC D-dimer test identified 49% of patients at low enough risk to withhold imaging tests (score of ≤3).…”