TITLE:
Recurrent Deep Vein Thrombosis (DVT) with Negative D-Dimer in a Patient on Rivaroxaban: A Diagnostic Pitfall
AUTHORS:
Jane Chaplin, Amin Shams Akhtari, Wei Lum
KEYWORDS:
Deep Vein Thrombosis, D-dimer, Direct Oral Anticoagulant, Rivaroxaban, Ultrasound, Diagnostic Algorithm
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.13 No.4,
November
7,
2025
ABSTRACT: We present a case of a 60-year-old female with a history of recurrent venous thromboembolism (VTE), who re-presented with right leg pain and was found to have a non-occlusive deep vein thrombosis (DVT) in the common femoral vein (CFV) despite being on rivaroxaban. Notably, the D-dimer was negative, and the Wells score was one. Duplex ultrasound confirmed non-compressibility of the CFV and femoral vein (FV). This case emphasizes the limitation of D-dimer testing in patients on direct oral anticoagulants (DOACs) and the importance of considering imaging even in low pre-test probability cases when clinical suspicion persists.