Practical diagnostic management of patients with clinically suspected deep vein thrombosis by clinical probability test, compression ultrasonography, and D-dimer test

Am J Med. 2002 Dec 1;113(8):630-5. doi: 10.1016/s0002-9343(02)01347-5.


Purpose: To evaluate a new noninvasive diagnostic strategy for ruling out deep vein thrombosis consisting of either a combination of low clinical probability and normal ultrasonography or a combination of moderate-to-high clinical probability, normal ultrasonography, and a normal D-dimer test.

Subjects and methods: We studied 811 patients with clinically suspected deep vein thrombosis using a diagnostic management strategy that combined clinical probability, ultrasonography, and measurement of D-dimers. The primary endpoint was venous thromboembolism occurring during a 3-month follow-up.

Results: Of the 280 patients (35%) with a low clinical probability, 30 (11%) had an abnormal initial ultrasonography and were treated. Of the other 250 untreated patients with low clinical probability and a normal ultrasonography, 5 (2%; 95% confidence interval [CI]: 1% to 5%) developed a nonfatal venous thromboembolism during follow-up. Of the 531 patients (65%) with a moderate-to-high clinical probability, 300 (56%) had an abnormal ultrasonography. Of the remaining 231 patients with a normal ultrasonography, 148 had a normal D-dimer test; none of these patients developed deep vein thrombosis during follow-up (0%; 95% CI: 0% to 3%). Of the 83 patients with an abnormal D-dimer test, 77 underwent repeat ultrasonography about 1 week later; none of the 64 patients with a second normal ultrasound developed symptomatic deep vein thrombosis during follow-up (0%; 95% CI: 0% to 6%).

Conclusions: This management strategy, which combines clinical probability, ultrasonography, and D-dimer measurements, is practical and safe in ruling out deep vein thrombosis in patients with clinically suspected thrombosis and reduces the need for repeat ultrasonography.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Phlebography / methods
  • Probability
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Ultrasonography, Doppler / methods*
  • Venous Thrombosis / blood*
  • Venous Thrombosis / diagnostic imaging*


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D