A Comparative Analysis of D-Dimer Assays in Patients with Clinically Suspected Pulmonary Embolism

Beek, Edwin Jacques Rudolph van; Ende, B. Van Den; Berckmans, René J.; Heide, Y.T. van der; Brandjes, D. P. M.; Sturk, Auguste; Cate, J. W. Ten

doi:10.1055/s-0038-1649595

Cited by 82 publications

(62 citation statements)

References 14 publications

(18 reference statements)

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“…D-dimer levels are elevated in venous thrombosis, 40 pulmonary embolism, 41 stroke, 42 and myocardial infarction, 43 with additional evidence that increased D-dimer levels may be a marker of subsequent thrombotic events. 44 Our finding of significantly …”

Section: Discussionmentioning

confidence: 99%

Postmenopausal Hormone Replacement Therapy Increases Coagulation Activity and Fibrinolysis

Teede

McGrath

Smolich

et al. 2000

ATVB

124

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Abstract-Hormone replacement therapy (HRT) appears to be cardioprotective in postmenopausal women; however, concerns exist over its thrombogenic effects. To address the effects of combined HRT on coagulation and fibrinolysis, we have measured circulating markers of these processes in a double-blind placebo-controlled trial. Forty-two healthy postmenopausal women aged 50 to 75 years received continuous combined HRT with 2 mg estradiolϩ1 mg norethisterone or placebo for 6 weeks. Hormone profiles were measured at baseline, and lipid and hemostatic parameters were measured at baseline and after 6 weeks of therapy. Baseline characteristics were similar in the 2 groups. With change from baseline the main outcome measure, HRT increased the markers of coagulation (prothrombin fragments 1ϩ2, 0.

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Section: Discussionmentioning

confidence: 99%

Postmenopausal Hormone Replacement Therapy Increases Coagulation Activity and Fibrinolysis

Teede

McGrath

Smolich

et al. 2000

ATVB

124

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“…However, a substantial proportion of patients with DVT have D-dimer concentrations that are only slightly increased (17,20,31,36,64 ). Many of the assays perform less well when required to accurately and reproducibly measure these slightly increased D-dimer concentrations (65 ), providing lower sensitivities and poor interand intraassay reproducibility (66,67 ). This is especially true for those tests that require an observer to determine the presence of agglutination (17,66 ).…”

Section: Differences Among D-dimer Assaysmentioning

confidence: 99%

D-Dimer Testing for Deep Venous Thrombosis: A Metaanalysis

Schectman²,

et al. 2004

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Background: The use of D-dimer assays as a rule-out test for deep venous thrombosis (DVT) is controversial.To clarify this issue we performed a systematic review of the relevant literature. Methods: We identified eligible studies, using MED-LINE entries from February 1995 through October 2003, supplemented by a review of bibliographies of relevant articles. Studies reporting accuracy evaluations comparing D-dimer test results with lower extremity ultrasound or venography in symptomatic patients with suspected acute DVT were selected for review. Two reviewers critically appraised each study independently according to previously established methodologic standards for diagnostic test research. Those studies judged to be of highest quality were designated Level 1. Results: The 23 Level 1 studies reported data on 21 different D-dimer assays. There was wide variation in assay sensitivity, specificity, and negative predictive values, and major differences in methodology of reviewed studies. A multivariate analysis of assay performance, controlling for sample size, DVT prevalence, reference standard, and patient mix, found few differences among the assays in effect on test performance as measured by diagnostic odds ratio. Increasing prevalence of DVT was associated with poorer test performance (P ‫؍‬ 0.01), whereas the choice of venography as the reference standard was associated with better test performance (P <0.005). Conclusions: Explanations for the wide variation in assay performance include differences in biochemical and technical characteristics of the assays, heterogeneity and small size of patient groups, and bias introduced by choice of reference standards. Assay sensitivity and negative predictive value were frequently <90%, un-

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“…Newer assays can be performed rapidly, making them suitable for use in individual patients. [43][44][45][46][47] The D-dimer assay is complementary to the clinical pretest probability because pulmonary embolism can be reliably excluded in patients with a negative D-dimer result and a low pretest probability. 41 The accuracy indices of 3 currently available D-dimer assay types are summarized in TABLE 8.…”

Section: D-dimer Assaymentioning

confidence: 99%

“…Before clinicians use a particular D-dimer assay to revise their pretest probability, they should be aware of the differences and interpret the results of the assay accordingly. 44,47 …”

Section: D-dimer Assaymentioning

confidence: 99%