Management of suspected deep venous thrombosis in outpatients by using clinical assessment and D-dimer testing

Ann Intern Med. 2001 Jul 17;135(2):108-11. doi: 10.7326/0003-4819-135-2-200107170-00011.


Background: When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis.

Objective: To determine whether the combination of a low clinical suspicion and a normal D -dimer result rules out deep venous thrombosis.

Design: Prospective cohort study.

Setting: Three tertiary care hospitals in Canada.

Patients: 445 outpatients with a suspected first episode of deep venous thrombosis.

Interventions: Patients were categorized as having low, moderate, or high pretest probability of thrombosis and underwent whole-blood D -dimer testing. Patients with a low pretest probability and a negative result on the D -dimer test had no further diagnostic testing and received no anticoagulant therapy. Additional diagnostic testing was done in all other patients.

Measurements: Venous thromboembolic events during 3-month follow-up.

Results: 177 (40%) patients had both a low pretest probability and a negative D -dimer result. One of these patients had deep venous thrombosis during follow-up (negative predictive value, 99.4% [95% CI, 96.9% to 100%]).

Conclusion: The combination of a low pretest probability of deep venous thrombosis and a negative result on a whole-blood D -dimer test rules out deep venous thrombosis in a large proportion of symptomatic outpatients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care*
  • Canada
  • Enzyme-Linked Immunosorbent Assay
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Follow-Up Studies
  • Humans
  • Prospective Studies
  • Risk Assessment
  • Venous Thrombosis / diagnosis*


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D