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To the Editor.—Dr Anand and colleagues¹ present a diagnostic algorithm for deep vein thrombosis (DVT) based chiefly on noninvasive diagnostic testing, such as clinical examination and compression ultrasonography, thus simplifying and reducing the expense of more complex and labor-intensive management strategies. However, owing to the analytical sensitivity of the plasma D-dimer, a value less than a given threshold should rule out the presence of concurrent thrombotic pathologies,^2-4 thus counterbalancing the rather limited sensitivity of the clinical examination.^{1, 5} In addition, compression ultrasonography requires dedicated instrumentation and skilled operators and shows critical interobserver variation.⁵ Conversely, plasma D-dimer can be measured using rapid, precise, and fully automated immunoassays that have up to 100% sensitivity.^2-4

Plasma D-dimer measurement has been shown to allow the rapid exclusion of about 30% of patients undergoing evaluations for DVT from other expensive, time-consuming, and more risky diagnostic procedures such as contrast venography.^{3, 6} Patients with low to moderate . . . [Full Text of this Article]

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