Lisette van Dam

Wells rule and D-dimer test in recurrent ipsilateral DVT 4 61 of recurrent venous thromboembolism (VTE), anticoagulation-associated major bleeding and all-cause mortality. Finally, all endpoints were adjudicated by an independent committee. For the current analysis, patients with unavailable Wells rule scores and/or D-dimer levels were excluded. Wells rule and D-dimer CDR assessment included both the original and modified Wells rule for DVT, since previous studies have suggested that the modified Wells rule may be more sensitive for recurrent DVT than the original rule. 12 D-dimer levels were measured with an automated, well-validated, high-sensitivity, quantitative D-dimer assay in accordance with local guidelines (STA-Liatest, Diagnostica Stago; Tina-quant, Roche Diagnostics; Innovance, Siemens). Primary and secondary aims The primary aim of this analysis was to evaluate the safety of ruling out acute recurrent (ipsilateral) DVT among patients without anticoagulant treatment. The incidence of recurrent DVT was evaluated in patients with an unlikely ruling according to the original and modified Wells rule separately, in combination with a normal D-dimer test result at baseline. The incidence of recurrent DVT included both recurrent DVT diagnosed at baseline by a MRDTI positive for DVT as well as recurrent VTE during the 3-month follow-up period in patients with a MRDTI negative for DVT. Secondary aims were twofold: 1. to evaluate the safety of ruling out acute recurrent DVT based on an unlikely CDR, according the Wells rule and modified Wells rule separately, in combination with a normal D-dimer test in patients who were on anticoagulant treatment at inclusion; 2. to estimate the number of ‘spared’ diagnostic imaging tests (MRTDI and/or CUS) when the original or modified Wells rule and D-dimer test would be applied before imaging tests. Definitions An unlikely CDR according the Wells rule was defined as a score of less than 2 points as described in Table 1. In the modified Wells rule one extra point is given to