Issues Surrounding Age-Adjusted <scp>D</scp>-Dimer Cutoffs That Practicing Physicians Need to Know When Evaluating Patients With Suspected Pulmonary Embolism

Goodwin, Andrew; Higgins, Russell A.; Moser, Karen; Smock, Kristi J.; Chandler, Wayne L.; Kottke‐Marchant, Kandice; Hartman, Sarah K.; Volod, Oksana; Brown, Alan; Johari, Vandita; Burr, Sharon; Polyakov, Nataliya; Chen, Dong

doi:10.7326/m16-2030

Cited by 23 publications

(19 citation statements)

References 7 publications

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“…Varying the threshold according to C‐PTP or age improves utility, but the safe threshold values differ from one assay to another. Laboratories and clinicians must be familiar with the literature on the D‐dimer assay used at their institution to interpret results …”

Section: D‐dimer Testing For Diagnosis Of Dvt and Pementioning

confidence: 99%

“…Laboratories and clinicians must be familiar with the literature on the D-dimer assay used at their institution to interpret results. 25 27 Overall, the evidence suggests that a positive D-dimer after completion of 3 months of anticoagulant therapy in patients with a first unprovoked VTE predicts a risk of recurrence that is approximately double the risk in patients with a negative D-dimer.…”

Section: Varying D-dimer Threshold According To Agementioning

confidence: 99%

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Review of D‐dimer testing: Good, Bad, and Ugly

Linkins

Lapner

2017

Int J Lab Hematology

215

166

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D-dimer assays are commonly used in clinical practice to exclude a diagnosis of deep vein thrombosis or pulmonary embolism. More recently, they have been also been used to guide patients with unprovoked venous thromboembolism (VTE) when faced with the decision to continue or stop anticoagulation after initial treatment is complete. D-dimer assays vary widely with respect to the antibody used, method of capture, instrumentation required, and calibration standard. These differences have an important influence on the operating characteristics of the assays. Consequently, the evidence available in the literature for one assay cannot simply be extrapolated to another. In this review, we will outline the general properties of D-dimer assays, discuss the concept of raising the D-dimer threshold used in diagnosis of VTE according to pretest probability and age, and provide clinical perspective on the role of D-dimer testing in the diagnosis and prognosis of VTE.

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Section: D‐dimer Testing For Diagnosis Of Dvt and Pementioning

confidence: 99%

Section: Varying D-dimer Threshold According To Agementioning

confidence: 99%

Review of D‐dimer testing: Good, Bad, and Ugly

Linkins

Lapner

2017

Int J Lab Hematology

215

166

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“…We are aware of several examples of D‐dimer use in clinical diagnostic algorithms and/or decision rules where application of the proposed algorithm or rule may be hampered if users cannot identify the correct D‐dimer unit or if the local laboratory's D‐dimer assay cannot be used in the proposed tool. For example, clinical guidelines published by the American College of Physicians (ACP) in 2015 challenged laboratories to decide whether age adjusted D‐dimer cutoffs used in protocols for exclusion of venous thromboembolism are safe and appropriate for use in their institutions, a decision which includes determination of whether or not their D‐dimer assays have sufficient data to support the use of age‐adjusted cutoffs . Unfortunately, the unit type (DDU versus FEU) of D‐dimer results was not clearly stated in the initial ACP guidance paper, but was subsequently corrected to indicate a unit type of FEU 11 .…”

Section: D‐dimermentioning

confidence: 99%

“…ng/mL, μg/mL, and μg/L) and two different unit types (D-dimer unit (DDU) and fibrinogen equivalent unit (FEU)) are regularly used, and a recent international survey identified 28 combinations of unit magnitude and type reported by survey participants. [4][5][6] Previously published EQA data from the College of American Pathologists (CAP) have demonstrated confusion resulting from different reporting units. 4 First, the CAP EQA data showed that some laboratories convert between unit types.…”

Section: -Dimermentioning

confidence: 99%

“…The lack of D-dimer assay standardization and confusion sur- data to support the use of age-adjusted cutoffs. 5,11 Unfortunately, the unit type (DDU versus FEU) of D-dimer results was not clearly stated in the initial ACP guidance paper, but was subsequently corrected to indicate a unit type of FEU 11 . Failure to communicate the D-dimer unit type is common in published literature in this area, including in a recent proposed guideline update for diagnosis of periprosthetic joint infections that does not specify either the D-dimer assay used by study sites or the D-dimer unit type.…”

Section: -Dimermentioning

confidence: 99%

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What have we learned from coagulation laboratory participation in external quality programs?

Smock

Moser

2019

Int J Lab Hematology

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Coagulation laboratory external quality assurance (EQA) programs provide information that satisfies regulatory requirements and improves laboratory quality, patient care, and safety. In addition to the value to individual laboratories, data from EQA programs benefits the laboratory community in multiple ways by providing a snapshot of laboratory practice and summarizing the performance of various methods in identifying normal and abnormal specimens and the effects of therapies or interfering substances. This review article aims to summarize and provide examples of some of the important lessons learned from coagulation EQA data, including issues related to non‐standardization, imprecision, and the effects of interfering substances.

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The D‐dimer assay

2019

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D-dimer is an indirect marker of fibrinolysis and fibrin turnover; this molecule exhibits unique properties as a biological marker of hemostatic abnormalities as well as an indicator of intravascular thrombosis. D-dimer is a soluble fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism. Because of this, the D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis in a number of clinical scenarios. Most commonly, D-dimer has been extensively investigated for excluding the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and for monitoring other conditions in which the patient is at high risk of bleeding or thrombosis. Limitations of the assay include D-dimer elevation in a constellation of clinical scenarios (age, pregnancy, and cancer) and lack of clinical standardization.

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Issues Surrounding Age-Adjusted D-Dimer Cutoffs That Practicing Physicians Need to Know When Evaluating Patients With Suspected Pulmonary Embolism

Cited by 23 publications

References 7 publications

Review of D‐dimer testing: Good, Bad, and Ugly

Review of D‐dimer testing: Good, Bad, and Ugly

What have we learned from coagulation laboratory participation in external quality programs?

The D‐dimer assay

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