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D-Dimer Testing to Exclude Recurrent DVT

Henry I. Bussey, Pharm.D., FCCP, FAHA
January, 2005

Review: Rathbun SW, Whitsett TL, Raskob GE. Negative d-Dimer result to exclude recurrent deep venous thrombosis: A management trial. Ann Intern Med. 2004; 839-845.

Although several studies have discussed using d-Dimer testing to rule out acute DVT or PE, we are unaware of similar data regarding patients with recurrent DVT. Because of the occurrence of post-thrombotic syndrome in patients with a prior DVT, it is often especially difficult to determine whether worsening symptoms are due to changes in the post-thrombotic syndrome or may represent a new thromboembolic event.

In the present study, investigators measured d-Dimer levels in 300 consecutive patients suspected of having a recurrent DVT. Those with a negative d-Dimer were not treated with anticoagulation and no further testing was done during the acute phase. Patients with a negative test were followed up in 3 months or less if new symptoms developed. Of 166 patients (55%) with a positive d-Dimer test, ultrasound results confirmed a new DVT in 54, was normal in 79, and inconclusive in 33. Of 134 patients (45%) with a negative d-Dimer, 1 had a confirmed venous thromboembolic event or VTE (0.75%). VTE could not be excluded in 6 with leg symptoms (5 had inconclusive tests, and 1 was not tested) and one patient who died. Even if these 7 patients were included as having a VTE, the incidence would be only 6%

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