Exclusion and diagnosis of deep vein thrombosis by a rapid ELISA D-dimer test, compression ultrasonography, and a simple clinical model

The classical clinical signs of jeep vein thrombosis (DVT) are unspecific a nd may be found in several other conditions besides DVT. Therefore, patient s suspicious of DVT are subjected to elaborate invasive or noninvasive evid ence-based procedures that actually confirm DVT in only 20% to 30% of patie nts in this setting. However, simple laboratory tests and noninvasive strat egies to exclude and diagnose DVT are becoming available in the clinical em ergency setting of outpatients. In the presented literature, a sound basis is provided for quantifying clinical judgment for the diagnosis of acute pr oximal DVT. The number of positive clinical findings at time of first suspi cion of DVT appears to correlate directly with the probability of acute pro ximal DVT. The modified clinical model of Landefeld and Wells for DVT allow s reasonable accurate classification of patients into low, moderate, and hi gh probability for suffering DVT. The rapid automated enzyme-linked immunoa bsorbant assay (ELISA) VIDAS D-dimer presently available can be rapidly per formed in daily practive and emergency situations and is accurate to a high degree, especially in ruling out ongoing venous thromboembolic processes. The sequential use of the rapid ELISA VIDAS D-dimer test and compression ul trasonography in a well-designed clinical setting using a simple clinical m odel predicts a significant improvement due to a high sensitivity near 100% for the exclusion and diagnosis of DVT in the majority of outpatients with suspect DVT. A prospective decision analysis management study is proposed to exclude and diagnose DVT based on the rapid ELISA VIDAS D-dimer test and compression ultrasonography within the context of a ready-to-use simple cl inical model. The proposed simple model of a rational diagnosis of deep vei n thrombosis (RADIA DVT) has to be tested in a large multicenter study of m ore than 1,000 outpatients with suspected DVT. This model would be less exp ensive, easy to perform, and likely yield a significant simplification and improvement of highly accurate evidence-based exclusion or diagnosis of DVT on the basis of which clear-cut indications of anticoagulation could be ap propriately initiated or safely withheld.