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Deep Venous Thrombosis in a Patient with a Moderate Pretest Probability and a Negative D-Dimer Test: A Review of the

Rasha A Al-Khafaji1,2, Louise Schierbeck1

  • 1Cardiology Department, Nordsjælland (North Zealand) University Hospital, Hillerød, Denmark.

Journal of Blood Medicine
|June 26, 2020
PubMed

Insights

Diagnosing deep-vein thrombosis (DVT) presents challenges, especially in patients on anticoagulation. Current algorithms may miss DVTs, necessitating refined diagnostic strategies and D-dimer test interpretation awareness.

Area of Science:

  • Medical Diagnostics
  • Vascular Medicine
  • Thrombosis Research

Background:

  • Current diagnostic strategies for venous thromboembolism (VTE) are evolving.
  • Deep-vein thrombosis (DVT) diagnosis relies on clinical probability scores and D-dimer testing.
  • Anticoagulation therapy can complicate DVT diagnosis.

Purpose of the Study:

  • To review diagnostic algorithms for DVT.
  • To highlight challenges in DVT diagnosis, particularly in specific patient subgroups.
  • To propose improvements for current diagnostic protocols.

Main Methods:

  • Case report of a DVT diagnosis in a patient on anticoagulation.
  • Discussion of diagnostic parameters for DVT.
  • Analysis of limitations in current diagnostic algorithms and D-dimer testing.

Main Results:

  • A case of DVT was diagnosed despite moderate pretest probability and a negative D-dimer test in a patient on rivaroxaban.
  • Current diagnostic algorithms present challenges and pitfalls, especially for patients on anticoagulation.
  • D-dimer testing has clinically relevant limitations that impact interpretation.

Conclusions:

  • Physicians must consider DVT possibility even in patients on anticoagulation.
  • Improved diagnostic strategies, including modified Wells' score and whole-leg ultrasound, may reduce missed DVT cases.
  • Awareness of D-dimer test limitations is crucial for accurate DVT diagnosis.

Keywords:
Wells’ scorecompression ultrasoundrecurrent thrombosisrivaroxaban

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