Safety of using the combination of the Wells rule and D-dimer test for excluding acute recurrent ipsilateral deep vein thrombosis
| Autor: | Lucia J.M. Kroft, Anders von Heijne, Waleed Ghanima, Marcel A. van de Ree, Lisette F. van Dam, Marcel M. C. Hovens, Frederikus A. Klok, Jostein Gleditsch, Mathilde Nijkeuter, Eli Westerlund, Menno V. Huisman, Herman M.A. Hofstee, Gargi Gautam, Stan Kolman, Jan Westerink, Robin E. Westerbeek, Charlotte E.A. Dronkers, Cornelis J. van Rooden, Albert T. A. Mairuhu |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
diagnosis diagnostic imaging Deep vein 030204 cardiovascular system & hematology clinical decision making Orginal Article Recurrent deep vein thrombosis deep vein thrombosis Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine recurrent Predictive Value of Tests D-dimer medicine Humans cardiovascular diseases Thrombus Venous Thrombosis medicine.diagnostic_test business.industry Incidence (epidemiology) Magnetic resonance imaging Thrombosis Original Articles Hematology medicine.disease Confidence interval medicine.anatomical_structure Radiology business |
| Zdroj: | Journal of Thrombosis and Haemostasis, 18(9), 2341-2348. WILEY Journal of Thrombosis and Haemostasis |
| ISSN: | 1538-7836 1538-7933 |
| Popis: | Background The diagnostic accuracy of clinical probability assessment and D‐dimer testing for clinically suspected recurrent deep vein thrombosis (DVT) is largely unknown. Aim To evaluate the safety of ruling out acute recurrent DVT based on an unlikely Wells score for DVT and a normal D‐dimer test. Methods This was a predefined endpoint of the Theia study in which the diagnostic accuracy of magnetic resonance direct thrombus imaging in acute recurrent ipsilateral DVT was validated. The Wells rule and D‐dimer test, performed as part of the study protocol, were not used for management decisions. The primary outcome of this analysis was the incidence of recurrent DVT at baseline or during 3‐month follow‐up for patients with an unlikely Wells score and a normal D‐dimer test. Results Results of both Wells score and D‐dimer tests were available in 231 patients without anticoagulant treatment. The recurrent DVT prevalence was 45% (103/231). Forty‐nine patients had an unlikely Wells score and normal D‐dimer test, of whom 3 (6.1%, 95% confidence interval [CI] 1.3%‐18%) had recurrent DVT at baseline/follow‐up, yielding a sensitivity of 97% (95% CI 92%‐99%) and specificity of 36% (95% CI 28%‐45%). Thus, if clinical probability scoring and D‐dimer testing would have been applied, radiological imaging could have been omitted in 21% of patients with a diagnostic failure rate of 6.1%. Conclusion By applying clinical probability scoring and D‐dimer testing, radiological imaging could be spared in one fifth of patients with suspected recurrent ipsilateral DVT. However, the high failure rate does not support implementation of this strategy in daily practice. |
| Databáze: | OpenAIRE |
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