Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis

Wells, Philip S.; Anderson, David R.; Rodger, Marc; Forgie, Melissa; Kearon, Clive; Dreyer, Jonathan; Kovács, George; Mitchell, Michael J.; Lewandowski, Bernard; Kovacs, Michael J.

doi:10.1056/nejmoa023153

Cited by 1,292 publications

(893 citation statements)

References 25 publications

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“…These conclusions are similar to those reported for outpatients without any previous history of DVT by other research groups [6][7][8]; only one false negative DD result was elicited in a patient scored as likely for the diagnosis of DVT, consistent with the higher rate of false negative DD results previously described in that group [8].…”

Section: Discussionsupporting

confidence: 90%

“…An initial clinical assessment by the attending physician was performed using the modified Wells' score for suspected DVT [8]. Patients scored as \DVT likely" or \DVT unlikely" were managed according to the diagnostic algorithms showed in Fig.…”

Section: Diagnostic Approachmentioning

confidence: 99%

“…Diagnostic algorithms using combined DD and clinical evaluation have proved to be useful and safe for exclusion of DVT in outpatients with a suspected first episode of venous thrombosis [6][7][8]. Whether this approach can be applied to outpatients with symptoms of recurrent DVT is currently unknown.…”

Section: Introductionmentioning

confidence: 99%

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Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. 82:41-44, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 90%

Section: Diagnostic Approachmentioning

confidence: 99%

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Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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“…Either Doppler or duplex ultrasound screening have been used as the gold standard in major studies 11, 12, 14. Although ultrasound can be carried out at the bedside non‐invasively without contrast material, the diagnostic accuracy is extremely sensitive to the experience of the examiner 19.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

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AimVenous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.MethodsWe examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.ResultsThe study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL.ConclusionsAt least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.

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“…Another confounding factor may be the length of hospital stay. According to the Wells score,18 patients bedridden for 3 days or more are considered at risk of DVT. However, although we measured the length of time from admission to the venous US (Table 1), we could not differentiate between the three groups (Tukey–Kramer method, P = 0.71).…”

Section: Discussionmentioning

confidence: 99%

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

Takechi

Dote

Kim

et al. 2017

Acute Medicine & Surgery

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AimWe hypothesized that the quality of the assessment of abnormal laboratory data in the emergency department (ED) could affect the hospital‐attending physicians’ decision‐making after a patient's hospitalization. To test this hypothesis, we investigated how patients with a positive D‐dimer result were reported by ED physicians in electronic medical records, and measured whether lower extremity venous ultrasonography examination was undertaken during hospitalization by the hospital‐attending physicians.MethodsIn an urban tertiary acute care general hospital in Japan, between January 2012 and December 2013, we included patients hospitalized after a positive D‐dimer measurement (≥1.0 μg/mL) that was taken in the emergency department. We retrospectively measured the quality of ED physician assessments. Then we examined whether that affected the decisions of attending physicians to order lower extremity venous ultrasonography examinations during hospitalization. The exposure variable was the quality of the ED physicians’ assessment of patients with positive D‐dimer results. The outcome was whether a lower extremity venous ultrasonography examination was ordered by the attending physician during hospitalization.ResultsWhen assessments were described by ED physicians for patients with positive D‐dimer results, the attending physicians frequently ordered lower extremity venous ultrasonography (odds ratio, 10.74; 95% confidence interval, 5.92–19.50), even if the assessments only contained “copied and pasted” laboratory data (odds ratio, 1.68; 95% confidence interval, 2.10–2.40).ConclusionsBetter documentation by ED physicians, regarding patients with positive D‐dimer results, strongly affected the decisions made by attending physicians to order lower extremity venous ultrasonography examination.

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Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis

Abstract: Deep-vein thrombosis can be ruled out in a patient who is judged clinically unlikely to have deep-vein thrombosis and who has a negative D-dimer test. Ultrasound testing can be safely omitted in such patients.

Cited by 1,292 publications

References 25 publications

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

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