Do not perform Duplex scan or Chest CT scan as first level tests for patients that, according to Wells or Geneva score, have a low probability of Deep Venous Thrombosis (DVT). D-dimer determination has a high sensitivity as a first level test.
DVT and Pulmonary Embolism (PE) are very rare in the absence of elevated D dimer levels or specific risk factors. DVT of the lower limbs is a common disease and it is usually suspected in the presence of swelling. Swelling may be due to orthopedic, cardiac or lymphatic disease. The majority of the Duplex scans performed for suspected DVT are negative and would be avoided by an inexpensive test such as D dimer determination. If the D dimer is negative and there are no risk factors we can discount a diagnosis of DVT.
Sources
1. Niimi R, Hasegawa M, Sudo A, Shi D, Yamada T, Uchida A. Evaluation of soluble fibrin and D-dimer in the diagnosis of postoperative deep vein thrombosis. Biomarkers. 2010; 15(2): 149-57.
2. Casati G, Panella M, Di Stanislao F, Vichi MC, Morosini P. Gestione per processi professionali e percorsi assistenziali. Progetto Formazione Qualità ISS, ARM, MS. Manuale 1, marzo 2005.
3. Di Minno G, Mannucci PM, Tufano A, Palareti G, Moia M, Baccaglini U, et al. First Ambulatory Screening on Thromboembolism ((FAST) Study Group. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost 2005; 3: 1459-66.
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.
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