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PAPERS: Enrico Bernardi, Paolo Prandoni, Anthonie W A Lensing, Giancarlo Agnelli, Giuliana Guazzaloca, Gianluigi Scannapieco, Franco Piovella, Fabio Verlato, Cristina Tomasi, Marco Moia, Luigi Scarano, and Antonio Girolami D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study BMJ 1998; 317: 1037-1040 [Abstract] [Full text]

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When to test for D Dimers

Kakil Ibrahim Rasul   (19 October 1998)

Outpatient testing for deep vein thrombosis

G Lloyd   (30 October 1998)

When to test for D Dimers 19 October 1998
Kakil Ibrahim Rasul, senior specialist in haematology and oncology Hamad Medical Corporation Send response to journal: Re: When to test for D Dimers	An important point missing from your article is when the test should be done. This should be within the the first few days - not more than 3 days from the onset of deep vein thrombosis.Otherwise the result of the test may be normal, because the half life of d.dimers is short.
Outpatient testing for deep vein thrombosis 30 October 1998
G Lloyd Send response to journal: Re: Outpatient testing for deep vein thrombosis	Bernardi et al rightly highlight the use of d-dimer testing as an adjunct to ultrasonography in the outpatient management of patients with suspected deep vein thrombosis (DVT) (1). Their protocol is compatible with that based on a validated clinical prediction guide (2,3), since the inclusion criteria are nearly identical. One third of the patients presenting to an outpatient department with suspected DVT, for example, are likely to be given a moderate pre-test probability (3). Most (86%) of these will have a normal ultrasound necessitating repeat scanning at one week. However by performing a d- dimer assay on those patients with a normal scan the number requiring further ultrasound is reduced to only 11% (1). By selectively combining a pre-test probability and d-dimer result there are significant advantages to be gained in terms of patient satisfaction and saving to the health service. Dr G.Lloyd Locum Consultant Accident & Emergency Department Weston General Hospital Uphill N.Somerset BS23 4TQ References: 1 Bernadi E., Prandoni P., Lensing A.W.A. et al. D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 1998;317:1037-1040. 2 Anand S.S., Wells P.S., Hunt D. et al. Does this patient have deep vein thrombosis? JAMA 1998;279:1094-1099. 3 Wells P.S., Anderson D.R., Bormanis J. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. The Lancet 1997;350:1795-1798.