COMMENTARY: Review: The Wells rule is more useful than individual clinical features for predicting risk for deep venous thrombosis

Stevens, Scott M.; Ageno, Walter
March 2006
ACP Journal Club;Mar/Apr2006, Vol. 144 Issue 2, p46
Academic Journal
This article reports that diagnosis of deep venous thrombosis (DVT) is challenging because of its nonspecific clinical presentation. Recent research has focused on strategies to exclude the diagnosis of suspected DVT and reduce the use of expensive imaging tests. Many such strategies depend on a sensitive assay for D-dimer, a breakdown product of fibrin. Unfortunately, the D-dimer test has insufficient negative predictive value to safely rule out DVT on its own. Several studies have evaluated the usefulness of combining clinical pretest probability of disease and a sensitive D-dimer test to assess the safety of a low posttest probability of DVT to exclude the diagnosis.


Related Articles

  • Diagnosis of deep vein thrombosis: results of a survey. Negus, David // Journal of the Royal Society of Medicine;Nov1978, Vol. 71 Issue 11, p796 

    The article presents a result of a survey, diagnosing deep vein thrombosis. At the said survey, most surgeons who are provided with questionnaires, stated that they or their junior staff regularly examined the legs of all postoperative patients. The next series of questions are concerned on the...

  • Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? Sandler, D. A.; Martin, J. F. // Journal of the Royal Society of Medicine;Apr1989, Vol. 82 Issue 4, p203 

    To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388...

  • Elevated Levels of Soluble Fibrin in Patients with Thrombosis or a Pre-Thrombotic State. Wada, Hideo; Matsumoto, Takeshi; Abe, Yasunori; Hatada, Tsuyoshi; Ota, Satoshi; Yamada, Norikazu; Sudo, Akihiro; Nakatani, Kaname; Uchida, Atsumasa; Ito, Masaaki; Suzuki, Kozi; Nobori, Tsutomu // Vascular Disease Prevention;Nov2008, Vol. 5 Issue 4, p227 

    Background: Soluble fibrin (SF) is considered to be useful for the diagnosis of thrombosis, however, evidence for the diagnosis of pre-thrombosis by SF is still not well established. Objective: The present study was designed to evaluate the usefulness of new SF assay (New SF) in the diagnosis of...

  • Commentary. Stevens, Scott M.; Ageno, Walter // Evidence Based Medicine;Apr2006, Vol. 11 Issue 2, p56 

    The article presents a comment on the study on the detection of presence or absence of deep vein thrombosis by using individual clinical features, structured risk scores and physicians' empirical judgments. DVT has non-specific clinical presentation. D-dimer, a breakdown product of fibrin, is...

  • D-dimer vs. Ultrasonography for DVT: Use Prediction Rule. SHAUGHNESSY, ALLEN F. // American Family Physician;9/1/2013, Vol. 88 Issue 5, p337 

    The article discusses a research paper on the importance of D-dimer testing in patients with possible deep venous thrombosis. It references the study "Selective D-Dimer Testing for Diagnosis of a First Suspected Episode of Deep Venous Thrombosis: A Randomized Trial," by L. A. Linkins et al.,...

  • Why clots rupture.  // GP: General Practitioner;8/4/2006, p1 

    The article reports on a study which has revealed that fibrin fibres which make up the matrix of a blood clot can stretch to three times their length without losing elasticity and six times their length before breaking. The study which has been conducted by U.S. scientists has also found that...

  • Thrombin Generation by Exposure of Blood to Endotoxin: A Simple Model to Study Disseminated Intravascular Coagulation. Stief, T. W. // Clinical & Applied Thrombosis/Hemostasis;Apr2006, Vol. 12 Issue 2, p137 

    Pathologic disseminated intravascular coagulation (PDIC) is a serious complication in sepsis. In an in-vitro system consisting of incubation of fresh citrated blood with lipopolysaccharides (LPS) or glucans and subsequent plasma recalcification plasmatic thrombin was quantified. Five hundred...

  • ABSTRACTS.  // Toxicologic Pathology;2006, Vol. 34 Issue 1, p119 

    The article presents abstracts of medical research about toxicologic pathology. They include "Instantaneous Heart Rate Variability in Awake Dogs: A Sensitive and Specific Assay for Safety Pharmacology," "An Adaptable Grading System and Criteria for Cardiovascular Device Evaluation," and...

  • Cutoff Values of D-Dimer and FDP in Plasma for the Diagnosis of Thrombosis. Kaneko, Toshihiro; Wada, Hideo; Onishi, Katsuya; Abe, Yasunori; Ota, Satoshi; Yamada, Norikazu; Matsmoto, Takeshi; Katayama, Naoyuki; Sudou, Akihiro; Uchida, Atsumasa; Nobori, Tsutomu // Vascular Disease Prevention;May2008, Vol. 5 Issue 2, p81 

    Fibrin-related markers, such as fibrin and fibrinogen degradation products (FDP) and D-dimer, are considered useful for the diagnosis of thrombosis. However, the evidence for making a diagnosis of thrombosis based on fibrin-related markers is still not yet well established. The plasma...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics