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.
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