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.


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