ORIGINAL ARTICLESExclusion of first-episode deep-vein thrombosis after-hours using D-dimerRathbun, Suman Wa; Whitsett, Thomas La; Raskob, Gary EbAuthor Information aCardiovascular Section, Department of Medicine, USA bDepartment of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA Received 9 October, 2006 Revised 5 June, 2007 Accepted 8 August, 2007 Correspondence to Suman W. Rathbun, MD, MS, Department of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd. WP 3120, Oklahoma City, OK 73104, USA Tel: +1 405 271 4742; fax: +1 405 271 4742; e-mail: email@example.com Blood Coagulation & Fibrinolysis: December 2007 - Volume 18 - Issue 8 - p 795-800 doi: 10.1097/MBC.0b013e3282f10145 Buy Metrics Abstract The objective of this study was to test the safety of withholding anticoagulant treatment and additional call-back diagnostic testing with ultrasound in patients who have a negative D-dimer at presentation. Patients with signs and symptoms of deep-vein thrombosis who presented to the emergency department after regular hours and on weekends underwent D-dimer testing using the STA-Liatest D-di. In patients with negative D-dimer results, heparin therapy was withheld, and no further diagnostic testing for deep-vein thrombosis was done as part of the initial evaluation. Patients with positive D-dimer results underwent compression ultrasonography. The primary outcome measure was a diagnosis of new symptomatic venous thromboembolism confirmed by diagnostic testing during the 3-month follow-up period. Of the 260 eligible patients, 81 (31%) had a negative D-dimer and 179 (69%) had a positive D-dimer. No patient with a negative D-dimer at presentation had confirmed venous thromboembolism at 3-month follow-up. Three patients died: one by intracranial hemorrhage secondary to cerebrovascular accident; and two deaths of indeterminate cause almost 3 months after entry. The automated assay for D-dimer, the STA-Liatest D-di, seems to provide a simple method with high clinical utility for excluding acute first-episode deep-vein thrombosis in symptomatic patients who present to the emergency room after regular hours. © 2007 Lippincott Williams & Wilkins, Inc.