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In reply. We are most grateful to Dr Siragusa for highlighting the important issue of the potential for false-negative results when plasma D-ds are used as an exclusionary test for VTE in patients already receiving heparin. In the report by Couturaud et al,¹ pooled data from 3 studies showed that D-d levels in patients with VTE decreased by 25% after 24 hours of anticoagulant therapy. Although the absolute levels at this stage were 10-fold higher than the reference limit, this still resulted in a small decrease in sensitivity that might be clinically significant. Furthermore, D-d assay may also be less sensitive in patients receiving ongoing oral anticoagulation who have a suspected new episode of VTE: in a retrospective study of 704 outpatients with suspected deep vein thrombosis (DVT), the overall sensitivity of the Minutex assay (Diapharma Group, Inc, West Chester, Ohio) was 99%, falling to 75% in 61 patients receiving . . . [Full Text of this Article]

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