Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism

Dunn, Kelsey; Wolf, Jacek; Dorfman, David M.; Fitzpatrick, Peter M.; Baker, Jacquelyn L.; Goldhaber, S.Z.

doi:10.1016/s1062-1458(02)01004-8

Cited by 20 publications

(22 citation statements)

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“…The filled circle at the bottom of each plot is the pooled sensitivity or specificity using a random-effects model. the pretest prevalence of PE was Ͻ10% even without the use of a decision rule or physician suspicion to select for low-risk individuals (27,28 ). Indeed, over the past 5 years, published studies of outpatients evaluated for PE with the D-dimer have demonstrated a steady reduction in the overall prevalence of PE, which suggests that physicians are becoming more comfortable with the Ddimer and are expanding its use in patients who might not be evaluated with an objective test if the only option for testing were the use of pulmonary vascular imaging.…”

Section: Discussionmentioning

confidence: 97%

Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis

et al. 2003

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Background: Clinicians in outpatient clinics and emergency departments desire an accurate quantitative Ddimer assay. The study objective was to evaluate the diagnostic performance characteristics of the latex turbidimetric D-dimer test in the diagnosis of pulmonary embolism (PE) in the emergency department population. Methods: We conducted a search of MEDLINE, EM-BASE, and bibliographies of previous systematic reviews with no language restriction. Experts in the field of PE research were contacted to identify unpublished studies. Prospective investigations involving predominately outpatient populations with suspected PE that used a turbidimetric D-dimer test were included. Two authors extracted data independently and assessed study quality based on the composition of the patient spectrum and the reference standard used. Consensus was reached by conference. The analysis was based on a summary ROC curve and combining sensitivity and specificity independently across studies using a random-effects model. Results: The search yielded 264 publications and 2 unpublished studies. Nine studies met the inclusion criteria and provided a sample of 1901 individuals. Eight of the nine studies were homogeneous in terms of both sensitivity and specificity. One study had similar sensitivity but higher specificity. Combining the studies yielded an overall sensitivity of 0.93 (95% confidence interval, 0.89 -0.96) and an overall specificity of 0.51 (95% confidence interval, 0.42-0.59).

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Section: Discussionmentioning

confidence: 97%

Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis

et al. 2003

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“…1 presents the D-dimer and stroke volume data, describcomes using the modified Rankin Scale (mRS) and modified Glasgow Outcome Scale (GOS), which places the scores in reverse order. To analyze the initial NIHSS results, we divided the patients into three categories according to this baseline NIHSS score : mild (0-6), moderate (7)(8)(9)(10)(11)(12)(13)(14)(15), and severe (16 and above) 1,38) .…”

Section: Discussionmentioning

confidence: 99%

Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke

Park

Koh

Choi

2011

J Korean Neurosurg Soc

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“…The high negative predictive value (99.6%) led these authors to conclude that a negative D-dimer Elisa assay can almost always exclude PE in the emergency department setting. 13 Further studies are necessary in patients undergoing full leg duplex ultrasonography before adopting this method for venous thrombosis diagnosis. Screening methods emphasizing cost-effectiveness are limited in that even one mistake in diagnosis may result in a preventable death.…”

Section: D-dimer Assaymentioning

confidence: 99%

Laboratory Markers in the Diagnosis of Venous Thromboembolism

et al. 2004

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Abstract-Selected blood tests may be useful in the diagnosis of venous thromboembolism (VTE), or in the identification of a congenital or acquired defect associated with the development of VTE. Several studies have shown the D-dimer assay to have a high negative predictive value but poor specificity when used in the detection of VTE. Yet in the emergency room setting, the D-dimer test may be useful if a detailed risk factor analysis for each patient is included in the diagnosis. The presence of such genetic thrombophilia markers as factor V Leiden, prothrombin 20210A mutation, and antiphospholipid antibodies significantly increases a patient's risk of a thrombotic event. The relative risk of thrombosis in factor V heterozygotes is at least 3 times higher than in the general population, whereas the increased risk of thrombosis in homozygotes is estimated to be 50-to 80-fold greater than those without the defect. Thromboembolic events are reported in approximately one third of antiphospholipid-positive patients. Other markers such as hyperhomocysteinemia and deficiencies of antithrombin, protein C, or protein S, when combined with the previous mutations, significantly increase a patient's risk of a thrombotic event. We feel that it is important to identify these ultra-high-risk patients to provide adequate counseling about the risk of thrombosis before elective surgical procedures. Often, lifelong anticoagulation may be needed as these patients and family members may need testing before taking birth control pills or hormonal replacement.

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Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism

Cited by 20 publications

References 0 publications

Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis

Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis

Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke

Laboratory Markers in the Diagnosis of Venous Thromboembolism

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