Prospective Evaluation of a Screening Protocol to Exclude Deep Vein Thrombosis on the Basis of a Combination of Quantitative D-Dimer Testing and Pretest Clinical Probability Score

Yamaki, Takashi; Nozaki, Motohiro; Sakurai, Hiroyuki; Takeuchi, Masaki; Soejima, Kazutaka; Kono, Taro

doi:10.1016/j.jamcollsurg.2005.06.267

Cited by 18 publications

(17 citation statements)

References 37 publications

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“…[6] published a modified score, adding an item for previously documented DVT. This modified Wells score has been validated in outpatients [6,13], emergency department patients[14], and inpatients from a university hospital [15]. The initial clinical model by Wells et al.…”

Section: Discussionmentioning

confidence: 99%

“…[16] showed a poor correlation between PCP and IDDVT diagnosis, but they enrolled only 36 patients and 19 patients with IDDVT, respectively. Other studies demonstrated a better negative predictive value of PCP for both proximal DVT and IDDVT [13,17]. However, most studies did not look for distal DVT [6,18,19], and the Wells score therefore seems to be able to stratify patients only for the risk of proximal DVT [20].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Wells et al [6] published a modified score, adding an item for previously documented DVT. This modified Wells score has been validated in outpatients [6,13], emergency department patients [14], and inpatients from a university hospital [15]. The initial clinical model by Wells et al was derived by the inclusion of IDDVT diagnosed by venography, but the subsequent validation studies using whole-leg ultrasonography gave contrasting results.…”

Section: Discussionmentioning

confidence: 99%

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The Wells rule and D‐dimer for the diagnosis of isolated distal deep vein thrombosis

Sartori

Cosmi

Legnani

et al. 2012

Journal of Thrombosis and Haemostasis

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Summary. Background: Pretest clinical probability with the Wells rule and D-dimer have been widely investigated for the diagnosis of symptomatic proximal deep vein thrombosis (DVT) of the lower limbs, but they have not been formally tested for symptomatic isolated distal DVT diagnosis. Objective: To evaluate the diagnostic accuracy of the Wells rule and D-dimer for isolated distal DVT. Design, Setting, and Patients: This was a single-center, cross-sectional study including 873 consecutive outpatients with suspected DVT, in whom pretest clinical probability determination, D-dimer determination (STA Liatest; cut-off of < 500 ng mL) and complete compression ultrasonography of both lower limbs were performed. Results: The isolated distal DVT prevalence was 12.4% (90/725). The sensitivity of the Wells rule for isolated distal DVT was 47% (95% confidence interval [CI] 36-57%), the specificity was 74% (95% CI 70-77%), and the negative and positive predictive values were 91% (95% CI 88-93%) and 20% (95% CI 15-26%), respectively. Patients with isolated distal DVT had higher D-dimer levels than patients without DVT (1759 ± 1576 vs. 862 ± 1079 ng mL )1 , P = 0.0001). D-dimer was negative in 13 patients with isolated distal DVT. D-dimer sensitivity and specificity for isolated distal DVT were 84% (95% CI 75-91%) and 50% (95% CI 46-54%), respectively, with a negative predictive value of 96% (95% CI 93-98%). In patients with low pretest clinical probability, the D-dimer negative predictive value was 99% (95% CI 95-100%). Conclusion: In clinically suspected DVT with negative proximal compression ultrasonography, pretest clinical probability with the Wells rule has a low diagnostic accuracy for isolated distal DVT. D-dimer has a better negative predictive value, but alone it does not exclude isolated distal DVT. In patients with low pretest clinical probability, D-dimer had a negative predictive value of > 95% for isolated distal DVT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Wells rule and D‐dimer for the diagnosis of isolated distal deep vein thrombosis

Sartori

Cosmi

Legnani

et al. 2012

Journal of Thrombosis and Haemostasis

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“…The combination of a low PTP and a normal D-dimer concentration can be considered a safe strategy for excluding thrombosis and for withholding anticoagulant therapy in patients with suspected VTE. [9][10][11][12][13][17][18][19] Several methods are commercially available for measuring D-dimer concentra- tions: (1) latex agglutination, (2) microplate ELISA, (3) immunofiltration (membrane ELISA), and (4) whole-blood agglutination. Among various D-dimer tests, ELISA-based techniques have the highest sensitivity and NPV for DVT.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a high PTP who showed an elevated D-dimer assay value and initial negative scan underwent repeat venous DU scanning after 1 week (Fig 1). 17 Patients with proven DVT were monitored for at least 3 months while receiving oral anticoagulation medication.…”

Section: Patientsmentioning

confidence: 99%

Combined use of pretest clinical probability score and latex agglutination D-dimer testing for excluding acute deep vein thrombosis

Yamaki

Nozaki

Sakurai

et al. 2009

Journal of Vascular Surgery

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Combination of a specific D-dimer level with the clinical probability score is most effective in low-risk PTP patients for excluding DVT. In moderate- and high-risk PTP patients, however, the recommended cutoff points of 1.0 microg/mL may be preferable. These results show that different D-dimer levels for patients differing in risk is feasible for excluding DVT using the latex agglutination D-dimer assay.

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D-dimer for the diagnosis of acute venous thromboembolism in the emergency department: a Janus-face marker

Manfredini

2006

Int Emergency Med

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Prospective Evaluation of a Screening Protocol to Exclude Deep Vein Thrombosis on the Basis of a Combination of Quantitative D-Dimer Testing and Pretest Clinical Probability Score

Cited by 18 publications

References 37 publications

The Wells rule and D‐dimer for the diagnosis of isolated distal deep vein thrombosis

The Wells rule and D‐dimer for the diagnosis of isolated distal deep vein thrombosis

Combined use of pretest clinical probability score and latex agglutination D-dimer testing for excluding acute deep vein thrombosis

D-dimer for the diagnosis of acute venous thromboembolism in the emergency department: a Janus-face marker

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