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In Reply: In response to Drs Quere and Righini, we believe that a second ultrasonography is warranted only if the first ultrasonography was limited to the proximal veins and the D-dimer test was abnormal. Our study demonstrated that a second ultrasonography can be safely spared in patients with a normal 2-point ultrasonography and a normal D-dimer at baseline. Our findings confirm data from 2 cohort studies investigating the role of D-dimer in the management of patients with suspected DVT.^1-2 In both studies the prevalence of DVT at the second ultrasonography test was comparable with that reported in our trial (3.7%; 95% confidence interval [CI], 2.2%-5.6%¹; and 5.7%; 95% CI, 1.9-12.8%,² respectively). The comparison with the study by Cogo et al³ may not be applicable because in that study all patients with a normal baseline ultrasonography underwent repeat testing at 1 week.

We agree that the treatment of distal thrombosis . . . [Full Text of this Article]

Enrico Bernardi, MD, PhD
enrico.bernardi@ulss7.it
Department of Emergency and Accident Medicine
Civic Hospital
Conegliano, Italy

Giuseppe Camporese, MD
Angiology Unit

Franco Noventa, MD
Group of Clinical Epidemiology
University Hospital
Padua, Italy

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