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For exclusion of venous thromboembolism it is recommended to test the D-dimer level in all patients in hospital; the level of > or =500 ng/ml suggests a high probability of venous thromboembolism. In this prospective study we evaluated whether diagnostic accuracy of the D-dimer level for exclusion of venous thromboembolism is affected by the use of heparin prophylaxis during initial hospital admission. We studied the D-dimer level in 958 consecutive inpatients from a university hospital. D-dimer levels were measured with a microplate enzyme-immunoassay test and were analyzed after a blood sample was taken upon arrival in the hospital, or the previous evening if hospitalization occurred the previous evening. When a blood sample had been taken the previous evening and the D-dimer level was > or =500 ng/ml, therapeutic anticoagulation was discontinued for the remainder of the hospital admission. No patient had venous thromboembolism during the study period. The levels of D-dimer were measured with a threshold of 100 ng/ml. The overall prevalence of venous thromboembolism was 1.4% (n = 14). D-dimer levels were elevated in eight of the ten cases of venous th
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