--- Ray McGlone <[log in to unmask]> wrote:
> I had thought that a D-dimer should not be requested
> on a patient with a clinical scoring of 3 or more as
> this was a high risk group for DVT. The patient
> should instead have a doppler etc. A normal D-dimer
> test in a high risk group would not be a 100%
> reassuring.
>
> However a trend has developed locally for all
> patients to need a D-dimer before any further
> investigation. So a Doppler may be refused even if
> the patient obviously has a DVT. e.g. drug addict
> injecting into groin with leg twice normal size.
What do you mean by a doppler? Do you mean a full
doppler U/S which requires a vascular trained
radiologist and about half an hour or a compression
U/S which can be done by a radiographer and takes 5
minutes? If the latter then you need a -ve D-dimer and
a -ve compression U/S before you can say that the
patient has a very low probability of DVT. At least
that is what I understand from the work done in London
and published (sorry don't have the reference to hand)
and is the policy we follow. Our imaging dept doesn't
have the radiologists or time to do full doppler U/S
on all potential DVT patients.
The problem with compression U/S is that it can miss
short isolated femoral vein thrombosis and a -ve
D-dimer does actually help you here.
Cheers Fred.
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