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Among patients at high risk for deep venous thrombosis (DVT), d-dimer testing probably is unnecessary, and direct evaluation with ultrasound is more appropriate. Conversely, among low-risk patients, d-dimer testing using a higher-than-usual threshold might rule out DVT in more patients without increasing the number of missed DVT cases.
To determine whether a selective testing strategy outperforms uniform d-dimer testing for all patients, researchers randomized 1723 patients (90% outpatients) with first suspected DVTs to a control group in which all patients underwent d-dimer testing using a single positive threshold for everyone (≥0.5 µg/mL) or to a selective testing group in which positive d-dimer thresholds differed for low- and moderate-r…