Current use of D-dimer for the exclusion of venous thrombosis in hospitalized patients

Abstract

D-dimer assay’s utility for excluding venous thromboembolism (VTE) in hospitalized patients is debatable. We aimed to assess the current use of D-dimer as a diagnostic tool for excluding VTE in hospitalized patients and examine a mandatory age-adjusted D-dimer (AADD) threshold for diagnostic imaging. Retrospective cohort study between 2014 to 2019 that included patients from medical and surgical wards with a positive AADD result drawn during their hospitalization. The outcomes were determining a D-dimer threshold requiring further evaluation and assessing the prognostic value of D-dimer in predicting clinically relevant VTE in hospitalized patients. The cohort included 354 patients, 56% of them underwent definitive diagnostic imaging, and 7.6% were diagnosed with VTE after a positive AADD within 90 days of follow-up. Mortality rates were higher in patients diagnosed with VTE (33.3% vs. 15.9%, p = 0.03). Patients with pneumonia and other infectious etiologies were less likely to be further evaluated by definitive imaging (p = 0.001). Patients with a respiratory complaint (p = 0.02), chest pain (p < 0.001), or leg swelling (p = 0.01) were more likely to undergo diagnostic imaging. Patients with D-dimer levels > X2 the AADD were at increased risk of VTE [OR 3.87 (1.45–10.27)]. At 90 days of follow-up, no excess mortality was observed for patients without diagnostic evaluation following elevated AADD. D-dimer may be used in hospitalized patients to exclude VTE using the traditional AADD thresholds, with a high negative predictive value. D-dimer levels > X2 the AADD usually mandates further diagnostic imaging, while lower levels, probably do not require additional workup, with a sensitivity of almost 80% and no excess mortality.

Clinical Characteristics of Asymptomatic Thromboembolism in Psychiatric Inpatients: A Retrospective Study

“…The D-dimer test is reliable for ruling out VTE in outpatient and emergency settings, 14 , 15 and also works well for hospitalized patients. 16 Notably, individuals with psychosis have a higher risk of VTE, 17–19 highlighting the importance of regularly checking their D-dimer levels for asymptomatic VTE. Our study reveals significant findings regarding patients diagnosed with asymptomatic VTE.…”

Human Genetic Variation in F3 and Its Impact on Tissue Factor–Dependent Disease

“…Given the high negative predictive value for D-dimer in excluding VTE, 72 it is plausible that F3 SNPs associated with elevated D-dimer may also be associated with clinical VTE. However, a meta-analysis of eight studies of venous thrombosis showed no association between rs12029080 and VTE in patients of European ancestry.…”