NICE (2012) Rivaroxaban for the Treatment of Deep Vein Thrombosis and Prevention of Recurrent Deep Vein Thrombosis and Pulmonary Embolism. National Institute for Health and Care Excellence (NICE), National Appraisal Guidance.

has been cited by the following article:

• 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.