Abstract:Previous studies have suggested the utility of D-Dimer ELISA assays in eliminating a diagnosis of pulmonary embolism (PE). Our objectives were to evaluate the performance of a new, rapid, quantitative, and automated Liatest D-Dimer Assay in patients with suspected PE. Three hundred eighty-six consecutive patients referred to our institution between March 1992 and December 1996 for clinically suspected PE, with recent clinical signs not exceeding 1 wk, were included in this study. Diagnosis of PE was based on c… Show more
“…Statistical modeling (not shown) suggests that correction for verification bias might narrow the difference between the tests further. Verification bias may, however, explain why the specificities and negative predictive values in our study are somewhat lower than those reported in previous studies (5,12,15,17,38 ). Selective D-dimer testing in only the low clinical probability group could have artificially increased the exclusion rates.…”
Section: Discussioncontrasting
confidence: 92%
“…On the other hand, the high falsepositive rate that has been noted for D-dimer testing may serve only to increase the number of patients evaluated for VTE, leading to increased morbidity and expense of clinical testing (27 ). Recently, several enhanced microlatex agglutination assays have become available commercially, and results of several studies of these assays appear promising (e.g., (12,17,18 ). Our study is one of the few to compare the diagnostic performance of the new Stago microlatex assay with ELISA D-dimer testing for inpatients and outpatients with suspected PE.…”
Section: Discussionmentioning
confidence: 99%
“…The details of the method have been described previously (17,18 ). The results were reported as mg/L of FEU; values above 4.0 mg/L were initially reported by the instrument as Ͼ4.0 mg/L, but a repeat test with a 1:5 dilution extended the reportable range to 20 mg/L.…”
Background:The ability of various D-dimer assays to exclude the diagnosis of thromboembolic diseases is controversial. We examined the diagnostic accuracy of two D-dimer methods in hospitalized patients and outpatients. Methods: We studied consecutive patients for whom D-dimer testing was ordered for investigation of suspected pulmonary embolism. We
“…Statistical modeling (not shown) suggests that correction for verification bias might narrow the difference between the tests further. Verification bias may, however, explain why the specificities and negative predictive values in our study are somewhat lower than those reported in previous studies (5,12,15,17,38 ). Selective D-dimer testing in only the low clinical probability group could have artificially increased the exclusion rates.…”
Section: Discussioncontrasting
confidence: 92%
“…On the other hand, the high falsepositive rate that has been noted for D-dimer testing may serve only to increase the number of patients evaluated for VTE, leading to increased morbidity and expense of clinical testing (27 ). Recently, several enhanced microlatex agglutination assays have become available commercially, and results of several studies of these assays appear promising (e.g., (12,17,18 ). Our study is one of the few to compare the diagnostic performance of the new Stago microlatex assay with ELISA D-dimer testing for inpatients and outpatients with suspected PE.…”
Section: Discussionmentioning
confidence: 99%
“…The details of the method have been described previously (17,18 ). The results were reported as mg/L of FEU; values above 4.0 mg/L were initially reported by the instrument as Ͼ4.0 mg/L, but a repeat test with a 1:5 dilution extended the reportable range to 20 mg/L.…”
Background:The ability of various D-dimer assays to exclude the diagnosis of thromboembolic diseases is controversial. We examined the diagnostic accuracy of two D-dimer methods in hospitalized patients and outpatients. Methods: We studied consecutive patients for whom D-dimer testing was ordered for investigation of suspected pulmonary embolism. We
“…The assay was precalibrated and allowed a 1-time testing on an automated analyzer. 37 According to the manufacturer, the linearity of the assay ranged from 0.0 to 4.0 mg/ml. Antithrombin activity was detected based on the inhibition of thrombin using a chromogenic substrate kit.…”
Section: Default Settings and Methods Of Human Assays Applied To The mentioning
Abstract. Reference intervals for coagulation parameters have been rarely determined in dogs for the STA CompactH automated coagulation analyzer, so it is the aim of the current study to validate assays and establish reference ranges for its use in canine specimens. Coagulation parameters were assessed in 56 healthy dogs with a median age of 2 years and evenly distributed sex. The 95% reference intervals were as follows: 1-stage prothrombin time 5 5.7-8.0 sec; activated partial thromboplastin time (APTT) 5 10.0-14.3 sec; thrombin time (TT) 5 11.9-18.3 sec; fibrinogen 5 1.3-3.1 g/l; antithrombin (AT) 5 107.9-128.0%; D-dimer 5 0.023-0.65 mg/ml; anti-factor Xa 5 0.04-0.26 IU/l; and activated protein C (APC) ratio 5 2.0-3.0. Protein C and S activity was markedly below (,220%) and factor VIII was 2-to 11-fold above the human calibration standard, so a standard curve had to be prepared from canine pooled plasma. Reference intervals for protein C, protein S, and factor VIII were 75.5-118.9%, 74.4-160.5%, and 70.9-136.4%, respectively, compared with a canine standard curve. Streptokinase-activated plasminogen assay was not suitable for dogs. There was no significant impact of sex on hemostasis test results. Factor VIII activity, AT, protein C, protein S, and APC ratio were overestimated in hemolytic plasma, whereas fibrinogen, TT, and APTT were underestimated. Lipemia resulted only in false-high D-dimers. This study provided useful reference intervals for dogs, but some human tests (i.e., protein C, protein S, factor VIII, and plasminogen) required modification.
“…Eğer klinik olasılık düşük ve perfüzyon sintigrafisi de düşük olasılıklı ise pulmoner emboli tanısından uzaklaştırır. Düşük olası-lıklı sintigrafi bulguları ve yüksek olasılıklı klinik birlikte ise veya tam tersi sözkonusu ise tanı diğer yöntemlerle desteklenmelidir [3,15,16].…”
Objective: Pulmonary thromboembolism (PTE) named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40-60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT), which is used extensively in recent years, with ventilation-perfusion (V/P) scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT.
Methods:The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patients's admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1 st and 8 th day of the admission.Results: D-dimer was measured as higher in 24 of 25 patients with asymptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%.
Conclusion:In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.Key words: Pulmonary, embolism, scintigraphy, tomography ÖZET Amaç: Pulmoner tromboemboli (PTE) sistemik venöz sistemde oluşan pıhtıların pulmoner vasküler yatağa göçü ile ortaya çıkan klinik tabloya verilen isimdir. Akut derin ven trombozu (DVT) sonrası ortalama %40-60 oranında asemptomatik PTE görülmekte ve bu durum sessiz klinik seyir nedeniyle fark edilmemektedir. Bu çalışmamızda akut alt ekstremite DVT'sine bağlı gelişen asemptomatik PTE tanısında hala günümüzde önemli bir yer tutan ventilasyon-perfüzyon (V/P) sintigrafisi ile son yıllarda kullanılmaya başlanan multi-detektor bilgisayarlı tomografinin (MDBT) sensitivite ve spesifitesini karşılaştırmayı amaçladık.Yöntemler: Çalışma alt ekstremite akut DVT nedeniyle kliniğimize yatırılarak tedavisi planlanan 25 hastada gerçekleştirildi. Gebeler, nüks DVT vakaları, müracaat esnasında semptomatik PTE tablosu olanlar, vena kavaya uzanım gösteren trombüsü olanlar, önceden geçirilmiş PTE öyküsü olanlar çalışmaya dahil edilmedi. Hastalarda DVT tanısı renkli doppler USG ile konulup, D-dimer testiyle teyit edildi. Hastalara yatışının 1.ve 8. günlerinde V/P sintigrafisi ve MDBT yapılarak asemptomatik PTE varlığı araştırıldı.
Bulgular:Pulmoner tromboemboli açısından asemptomatik olan 25 DVT hastasının 24'ünde D-dimer normalin üstünde ölçüldü. MDBT ile 10 hastaya PTE tanısı konuldu. Akut DVT'ye bağlı %40 oranında asemptomatik PTE geliştiği tespit edildi.Sonuç: Multi-detektor bilgisayarlı tomografi tanı değeri açısından V/P sintigrafisinden daha faydalı bulundu.
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