D-Dimer plasma concentration in various clinical conditions: Implication for the use of this test in the diagnostic approach of venous thromboembolism

Raimondi, Pierre; Bongard, O; Moerloose, Philippe de; Reber, Guido; Waldvogel, Francis; Bounameaux, Henri

doi:10.1016/0049-3848(93)90009-d

Cited by 123 publications

(70 citation statements)

References 15 publications

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“…D-dimer levels above the cutoff that excludes thrombosis have been documented in absence of thrombosis in the elderly and in patients with numerous other conditions including infections, cancer, coronary, cerebral and peripheral arterial vascular disease, heart failure, rheumatologic diseases, surgery, trauma burns, and pregnancy. [18][19][20][21] Van Beek et al 22 and Miron et al 23 demonstrated that d-dimer testing was not useful in hospitalized patients. Kabrhel et al 24 reported similar results in an Emergency Department cohort and concluded that d-dimer testing increased the percent of patients who were investigated for PE and the percent that were sent for pulmonary vascular imaging without increasing the percent of patients diagnosed as having a PE.…”

Section: Discussionmentioning

confidence: 99%

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

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BACKGROUND:The usefulness of the Wells score has not been assessed in hospitalized patients receiving prophylactic heparin.METHODS:Retrospective, observational study of hospitalized patients receiving prophylactic heparin who underwent contrast‐enhanced chest computed tomography (CT) for a concern of pulmonary embolism (PE) more than 2 days after admission. Patients with contraindications to, or interruptions in, prophylactic heparin were excluded. The modified (eg, dichotomous) Wells score was retrospectively calculated by reviewing each patient's record. Requesting a d‐dimer was taken to mean that alternate diagnoses were of equal or greater likelihood than acute PE.RESULTS:From January 2006 through December 2007, 286 patients met inclusion criteria. Pulmonary embolus diagnosed by CT was present in 20 patients (7%). The sensitivity, specificity, positive and negative predictive values of a Wells score ≥4.0 were 95%, 27%, 9% and 99%, respectively. A d‐dimer was ordered in 70 of the 74 PE‐unlikely cases, was elevated in 67, and falsely positive in all but 1.CONCLUSIONS:The prevalence of PE in hospitalized patients receiving prophylactic heparin is lower than in cohorts from which the Wells prediction criteria were derived and validated. A modified Wells score <4 safely excludes PE in such patients and reduces the need for CT. D‐dimer testing adds nothing to the evaluation. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

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“…This is because confounders affect the D-dimer values of hospitalized patients, thereby resulting in a positive D-dimer test without a thromboembolic event; consequently a CTPA is necessary to demonstrate or rule out a PE [31]. Malignant disorders, cirrhosis of the liver, myocardial infarction, sepsis, renal insufficiency, trauma, infections and other diseases are related to an increase in D-dimer concentration [14,15,32]. This is also due to the fact that the D-dimer average value of patients undergoing a CTPA in the hospital environment tended to be higher without reaching a significant level, however.…”

Section: Synopsis and Integration Of The Most Important Resultsmentioning

confidence: 99%

Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism

Altmann

Wrede

Peetz

et al. 2015

Fortschr Röntgenstr

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Purpose: To evaluate the effect of an age-dependent D-Dimer cut-off in patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism (PE) Material and Methods: Retrospective application of an age-dependent D-dimer cut-off (age/100 in patients aged over 50) in 530 consecutive patients, both in- and outpatients, aged over 18, who underwent CTPA for suspected PE according to the guidelines. Results: The application of an age-dependent D-dimer cut-off showed a now negative test-result in 17 of 530 patients (3.2?%). The proportion was 4.1?% (17 of 418) in patients aged over 50. None of these 17 cases was diagnosed with PE in CTPA, the false-negative rate was 0?%. The effect could be seen in outpatients (14 of 377 [3.7?%]) as well as in inpatients(3 of 153 [2.0?%]) with no statistically significant difference (p?>?0.05). Conclusion: The application of an age-dependent D-dimer cut-off as part of the guidline-based algorithm for suspected PE reduced the number of necessary CTPA in outpatients as well as in inpatients. Key points: ??The application of an age-dependent D-dimer cut-off reduces the number of CTPA as part of the diagnostic algorithm in patients suspected for PE No reduction in diagnostic safety was found ??The age adjustement performed equally in outpatients and inpatients Citation Format: ??Altmann MM, Wrede CE., Peetz D et?al. Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism. Fortschr R?ntgenstr 2015; 187: 795???800

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“…All reported higher sensitivities for patients with clot extending to the thigh than for clot limited to the calf (75 ). D-Dimer assays are also often positive in common conditions other than DVT, including cancer, recent trauma, or surgery (76 ). Studies in which many patients with these and other conditions associated with increased D-dimer concentrations are enrolled are likely to find higher D-dimer concentrations in patients classified as free of DVT and to report lower specificities.…”

Section: Heterogeneity Of Patient Groupsmentioning

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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D-Dimer plasma concentration in various clinical conditions: Implication for the use of this test in the diagnostic approach of venous thromboembolism

Cited by 123 publications

References 15 publications

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism

D-Dimer Testing for Deep Venous Thrombosis: A Metaanalysis

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