Comparison of four rapid D-Dimer tests for diagnosis of pulmonary embolism

Veitl, Marvio; Hamwi, A.; Kurtaran, Amir; Virgolini, Irene; Vukovich, Th.

doi:10.1016/0049-3848(96)00089-8

Cited by 27 publications

(10 citation statements)

References 15 publications

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“…We believe the diagnosis of UAP at admission to the ED should be based on clinical factors such as history, physical examination, and electrocardiography, and not on blood markers. Moreover, the generally low specificity of the available D-dimer assays (ELISA, latex agglutination assay, turbidometric immunoassays) and their wide variations in sensitivity [16][17][18] preclude their use as a diagnostic tool [16,[19][20][21][22]. Because of the low interassay correlation [21,22] and the lack of a D-dimer reference standard, we used the ELISA, which is currently considered the gold-standard methodology.…”

Section: Discussionmentioning

confidence: 99%

Role of ELISA D‐dimer test in patients with unstable angina pectoris presenting at the emergency department with a normal electrocardiogram

Shitrit¹,

Shitrit²,

Rudensky³

et al. 2004

American J Hematol

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Patients with unstable angina pectoris and acute myocardial infarction have higher than normal D-dimer levels. The aim of the study was to determine the value of the D-dimer test in patients with unstable angina pectoris and a normal electrocardiogram on presentation at the emergency department. The study sample included 81 patients who met these criteria. Blood samples collected at admission were subjected to ELISA D-dimer. Findings were correlated with coronary risk factors, use of cardiac medications, blood levels of acute phase reactants (fibrinogen and C-reactive protein), cardiac enzymes levels, length of hospital stay, and catheterization findings. ELISA D-dimer levels were statistically significantly correlated with cardiac risk factors, namely male sex, older age, smoking, and hypertension (r = 0.25, P = 0.02; r = 0.43, P = 0.0001; r = 0.26, P = 0.03; r = 0.35, P = 0.002, respectively), in addition to use of cardiac medications (beta blockers, aspirin, nitrates), levels of acute phase reactants, length of stay, and catheterization findings. On multivariate analysis, only D-dimer level, age, and sex were predictors of length of stay (P = 0.018). The study suggests that D-dimer levels at admission to the emergency department may serve as an additional tool to predict the magnitude of unstable angina pectoris in patients with a normal electrocardiogram. Am.

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Section: Discussionmentioning

confidence: 99%

Role of ELISA D‐dimer test in patients with unstable angina pectoris presenting at the emergency department with a normal electrocardiogram

Shitrit¹,

Shitrit²,

Rudensky³

et al. 2004

American J Hematol

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“…It has had extensive trials. Under laboratory conditions and single institution gold standard trials it was 88–100% sensitive 52–54 . However later multi‐institution studies found sensitivity dropped considerably (85%), 55 although the test seemed useful in low PTP patients.…”

Section: Simpli‐redmentioning

confidence: 95%

Diagnosing pulmonary embolism: A question of too much choice?

Mountain

2003

Emergency Medicine

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The diagnosis of pulmonary embolism (PE) is difficult with many patients treated without the disease or left untreated without an adequate diagnostic work up. Recent advances in PE diagnosis are reviewed. The use of risk stratification in PE diagnosis is strongly recommended and evidence on how it can best be performed summarized. The Ginsberg/Wells stratification rule is recommended currently as the best validated rule. Computed tomographic pulmonary angiography (CTPA) was found to have quite poor sensitivity and to be poorly validated. It is recommended as adequate as a positive test in moderate/high risk groups and an exclusionary test in low risk groups or where an adequate alternative diagnosis is found. For D‐Dimer tests the only test with adequate sensitivity and validation in management studies is the VIDAS© D‐Dimer. This is in low/intermediate risk groups in the ED population. The Simpli‐Red© test is also reviewed but is too insensitive for most populations. Echocardiography: this is good in compromised patients as it is a bedside test which when negative virtually excludes PE. If positive in the right setting it has a high positive predictive value. A negative echocardiogram predicts a benign clinical course for PE. The rest of the paper details the authors approach to integrating these new techniques with established algorithms and where progress is likely to occur in the next few years. These include improvements in CTPA (plus the addition of CT venography), new point of care D‐Dimer tests, better risk stratification rules and integration of new strategies with artificial neural networks or computerized guidelines.

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“…First, some D-dimer assays cross-react with products of fibrinogen degradation. 8,9 Second, and probably more important, in the clinical setting, serum Ddimer concentrations may be elevated secondary to processes other than thromboembolism that cause fibrin deposition, including inflammatory, infectious, neoplastic, and traumatic insults. This study examined the role of a common source of minor trauma in the clinical setting, IV insertion.…”

Section: Discussionmentioning

confidence: 99%