Kraaijenhagen Roderik A, Piovella Franco, Bernardi Enrico, Verlato Fabio, Beckers Erik A M, Koopman Maria M W, Barone Marisa, Camporese Giuseppe, Potter Van Loon Bert Jan, Prins Martin H, Prandoni Paolo, Büller Harry R
Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Arch Intern Med. 2002 Apr 22;162(8):907-11. doi: 10.1001/archinte.162.8.907.
The standard diagnostic approach in patients with suspected deep vein thrombosis is to repeat the compression ultrasonography after 1 week in all patients with an initial normal result. We hypothesized that a normal finding of a D-dimer assay safely obviates the need for repeated ultrasonography. In addition, we evaluated the potential value of a pretest probability assessment for this purpose.
At presentation, consecutive outpatients with suspected thrombosis underwent independent assessment by means of ultrasonography of the proximal veins, a whole-blood D-dimer assay, and a pretest clinical model. Patients with normal ultrasonographic findings and an abnormal D-dimer assay result were scheduled for repeated ultrasonography. We evaluated the incidence of symptomatic venous thromboembolic complications during a 3-month follow-up, and the value of clinical pretest probability with ultrasonography or D-dimer assay in scenario analyses.
We studied 1756 patients with prevalence of thrombosis of 22%. At entry, results of the D-dimer assay and ultrasonography were normal in 828 patients (47%). Of these, 6 returned with confirmed symptomatic venous thromboembolism (complication rate, 0.7%; 95% confidence interval [CI], 0.3%-1.6%). Repeated ultrasonography was avoided in 61% of the patients with an initial normal test result. Scenario analyses disclosed that the complication rate was 1.6% (95% CI, 0.8%-2.6%) in those with a low clinical pretest probability and a normal result of ultrasonography at referral, whereas this figure was 1.8% (95% CI, 0.9%-3.3%) in patients with a low clinical probability result and a normal result of the D-dimer assay at referral.
It is safe to withhold repeated ultrasonography in patients with suspected deep vein thrombosis who have normal results of ultrasonograpy and the SimpliRED D-dimer assay at presentation. The combination of a low clinical pretest probability with a normal result of compression ultrasonography or the D-dimer assay appears to be equally safe in refuting the diagnosis of deep vein thrombosis.
对于疑似深静脉血栓形成的患者，标准诊断方法是对所有初次检查结果正常的患者在1周后重复进行加压超声检查。我们推测D - 二聚体检测结果正常可安全地避免重复超声检查的必要性。此外，我们评估了用于此目的的预检概率评估的潜在价值。
就诊时，连续的疑似血栓形成门诊患者接受近端静脉超声检查、全血D - 二聚体检测和预检临床模型的独立评估。超声检查结果正常但D - 二聚体检测结果异常的患者安排重复超声检查。我们评估了3个月随访期间有症状静脉血栓栓塞并发症的发生率，以及在情景分析中临床预检概率与超声检查或D - 二聚体检测的价值。
我们研究了1756例患者，血栓形成患病率为22%。就诊时，828例患者（47%）的D - 二聚体检测和超声检查结果正常。其中，6例出现确诊的有症状静脉血栓栓塞（并发症发生率，0.7%；95%置信区间[CI]，0.3% - 1.6%）。61%初次检查结果正常的患者避免了重复超声检查。情景分析显示，转诊时临床预检概率低且超声检查结果正常的患者并发症发生率为1.6%（95% CI，0.8% - 2.6%），而转诊时临床概率结果低且D - 二聚体检测结果正常的患者这一数字为1.8%（95% CI，0.9% - 3.3%）。
对于就诊时超声检查和SimpliRED D - 二聚体检测结果正常的疑似深静脉血栓形成患者，不进行重复超声检查是安全的。临床预检概率低与加压超声检查或D - 二聚体检测结果正常相结合，在排除深静脉血栓形成诊断方面似乎同样安全。
