Fibrin D-Dimer Concentration, Deep Vein Thrombosis Symptom Duration, and Venous Thrombus Volume

Kurklinsky, Andrew K.; Kalsi, Henna; Wysokiński, Waldemar E.; Mauck, Karen F.; Havyer, Rachel D.; Thompson, Carrie A.; Hayes, Sharonne N.; McBane, Robert D.

doi:10.1177/0003319710382416

Cited by 26 publications

(18 citation statements)

References 13 publications

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“…In that review, both sensitivity and negative predictive values (NPV) were 100%, when both clinical assessment and DD were used; but dropped to 80% and 95%, respectively, when only DD was used. In our report, the need for VDU dropped exponentially from using DD alone, using Wells criteria alone, to Wells criteria (3) and DD; from 84, to 44, to 27%, respectively.…”

Section: Discussionmentioning

confidence: 62%

“…Studies have demonstrated DD as a sensitive and accurate essay to correlate, not only with the presence, but also with the volume of thrombus. (3) In addition, DD has a negative predictive value >95%, which allows for exclusion of VTE in selected patients. (4–9) A metaanalysis(10) conducted over three decades reported that enzyme-linked immunosorbent assays (ELISA), in general, dominate the comparative ranking among all DD assays for sensitivity, negative likelihood ratio, and a negative result on quantitative rapid ELISA, which is as diagnostically useful as venous duplex ultrasound (VDU) findings.…”

Section: Introductionmentioning

confidence: 99%

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Appropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital

Mousa

Broce

Gill

et al. 2015

Annals of Vascular Surgery

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BACKGROUND The sensitivity of D-dimer (DD) in detecting deep venous thrombosis (DVT) is remarkably high, however many institutions send patients immediately for a venous duplex ultrasound (VDU). This study was designed to examine the appropriate utilization of DD and VDU in a high volume hospital. METHODS A retrospective study was conducted on consecutive patients who presented to a high volume emergency department (ED) with lower extremity limb swelling/pain over a 30-day period, who were sent for VDU during an evaluation for DVT. VDU data were merged with electronic DD lab results. The enzyme-linked immunosorbent assay (ELISA) method was used to provide DD values and thresholds. Values above 0.60 mg/SEU were considered abnormal. RESULTS We reviewed the medical records of 517 ED patients in the month of June, 2013. After applying the Wells criteria, 157 patients (30.4%) were excluded due to a history of DVT or PE, having been screened for shortness of breath, or sent for surveillance; leaving 360 for analysis. The average age was 59.3±16.5 years with more females (210, 58.3%), and the majority reported limb pain or swelling (73.9%). DD was performed on 51 patients with an average value of 3.6±5.4 mg/SEU, of which 43 (84.3%) were positive. DD identified all positive and negative DVT patients (100% sensitivity and negative predictive value), but also included 40 false positives (16.7% specificity). On the other hand, 309 patients were sent directly to VDU without DD; of those, 43 (13.9%) were positive for DVT. However, 266 (86.1%) patients were negative for DVT by VDU without DD, and these were deemed improper by our current study protocol. Potential charge savings were calculated as VDU for all (360 × $1000 = $360,000), DD for all (360 × $145=$52,200), and VDU for both true and false positives (estimated to be about 25% of the cases; 90 × $1000 = $90,000); this equals a charge savings of $217,800 and would avoid unnecessary VDUs. CONCLUSIONS Based on the results of our study, we suggest that the DD test be utilized during the initial workup for patients with limb swelling/pain in the emergency room. Appropriate utilization of DD, as well as other clinical criteria, may limit the over-utilization and added cost of VDU, without a negative impact on patient care. The results of DD tests should be utilized to limit the number of patients sent for VDU to only those patients with a positive DD or other significant underlying concerns.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Appropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital

Mousa

Broce

Gill

et al. 2015

Annals of Vascular Surgery

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“…In patients with pulmonary embolism, the D‐dimer concentration is related to thrombus volume assessed by contrast‐enhanced CT,29 and a high D‐dimer concentration of >5000 ng/mL is a risk factor for in‐hospital mortality 30. Similarly, in patients with deep vein thrombosis, the ultrasound‐based estimated thrombus volume correlates with the D‐dimer concentration 31. These findings are consistent with the finding that D‐dimer elevation is associated with extensive aortic dissection 12, 13, 14.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

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BackgroundClinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified.Methods and ResultsD‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21).ConclusionsD‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.

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“…28 However, the duration of symptoms is known to be a poor measure of thrombus volume and characteristics. 36 Furthermore, thrombus itself may be heterogeneous, with older and fresher components. Although the ATTRACT trial will add to consideration of optimal timing for intervention in the setting of acute proximal thrombosis based on symptom duration, the effect of thrombus heterogeneity and actual thrombus age may be difficult to elucidate.…”

Section: Case Selectionmentioning

confidence: 99%

A Systematic Review of Percutaneous Mechanical Thrombectomy in the Treatment of Deep Venous Thrombosis

Karthikesalingam

Young

Hinchliffe

et al. 2011

European Journal of Vascular and Endovascular Surgery

122

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Fibrin D-Dimer Concentration, Deep Vein Thrombosis Symptom Duration, and Venous Thrombus Volume

Abstract: Despite varying symptom duration prior to diagnosis, fibrin D-dimer remains a sensitive measure of venous thrombosis and correlates with thrombus volume.

Cited by 26 publications

References 13 publications

Appropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital

Appropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

A Systematic Review of Percutaneous Mechanical Thrombectomy in the Treatment of Deep Venous Thrombosis

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