Safety of D‐dimer testing as a stand‐alone test for the exclusion of deep vein thrombosis as compared with other strategies

Fronas, Synne G.; Wik, Hilde Skuterud; Dahm, Anders Erik Astrup; Jørgensen, Camilla Tøvik; Gleditsch, Jostein; Raouf, Nezar; Klok, Frederikus A.

doi:10.1111/jth.14314

Cited by 25 publications

(19 citation statements)

References 34 publications

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“…We have previously reported on the safety of stand-alone D-dimer for the exclusion of DVT in 913 of the patients included in this study, and compared its safety and feasibility to standard diagnostic workup, as well as age-adjusted D-dimer. 6 Our findings were recently validated in a retrospective study. 11…”

Section: Objectives and End Pointssupporting

confidence: 67%

“…Moreover, both components of the strategy, stand-alone D-dimer and whole-leg CUS, had comparably low failure rates, similar to previous literature. 6,13,14 To our knowledge, this is the first study to assess the clinical outcomes of withholding anticoagulation treatment in a diagnostic strategy combining stand-alone D-dimer and single whole-leg CUS.…”

Section: Principal Findingsmentioning

confidence: 99%

“…To our knowledge, comparisons between alternative D-dimer thresholds, such as stand-alone, age-adjusted, and C-PTP-adjusted D-dimer, have been retrospective. 6,11,34 For future research, a prospective multicenter study with a head-to-head comparison of the various strategies would be useful in determining the optimal strategy. Future research efforts aimed at obviating unnecessary diagnostic workup altogether would further advance the management of patients with suspected DVT, for instance, by identifying new biomarkers and/or developing machine-learning strategies.…”

Section: Strengths Limitations and Clinical Implicationsmentioning

confidence: 99%

“…In a recent study, we found that negative stand-alone D-dimer safely ruled out DVT irrespective of C-PTP while necessitating fewer CUS examinations than if C-PTP had also been considered. 6 We believe a diagnostic strategy in which only patients with positive D-dimer are referred for a single whole-leg CUS regardless of C-PTP may simplify the workup of DVT without compromising safety. As such, this prospective management trial aimed to determine the safety and feasibility of such a strategy.…”

Section: Introductionmentioning

confidence: 98%

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Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

et al. 2020

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Guidelines for the diagnostic workup of deep vein thrombosis (DVT) recommend assessing the clinical pretest probability before proceeding to D-dimer testing and/or compression ultrasonography (CUS) if the patient has high pretest probability or positive D-dimer. Referring only patients with positive D-dimer for whole-leg CUS irrespective of pretest probability may simplify the workup of DVT. In this prospective management outcome study, we assessed the safety of such a strategy. We included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected DVT between February 2015 and November 2018. STA-Liatest D-Di Plus D-dimer was analyzed for all patients, and only patients with levels ≥0.5 µg/mL were referred for CUS. All patients with negative D-dimer or negative CUS were followed for 3 months to assess the venous thromboembolic rate. One thousand three hundred ninety-seven patients were included. Median age was 64 years (interquartile range, 52-73 years), and 770 patients (55%) were female. D-dimer was negative in 415 patients (29.7%) and positive in 982 patients (70.3%). DVT was diagnosed in 277 patients (19.8%). Six patients in whom DVT was ruled out at baseline were diagnosed with DVT within 3 months of follow-up for a thromboembolic rate of 0.5% (95% confidence interval, 0.2-1.2). A simple diagnostic approach with initial stand-alone D-dimer followed by a single whole-leg CUS in patients with positive D-dimer safely ruled out DVT. We consider this strategy to be a valuable alternative to the conventional workup of DVT in outpatients. This trial was registered at www.clinicaltrials.gov as #NCT02486445.

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Section: Objectives and End Pointssupporting

confidence: 67%

Section: Principal Findingsmentioning

confidence: 99%

Section: Strengths Limitations and Clinical Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

et al. 2020

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“…The diagnostic criteria for thrombosis are recommended that patients determined to have a low risk for DVT, the negative D-dimer accurately ruled out UEDVT without the need for CDU or other imaging tests and helped avoid unnecessary anticoagulant treatment( Fig.1) [1,[9][10][11][12]. However, the algorithm fails when low scores are assigned to patients with VT or when tests give falsenormal D-dimer levels [13].…”

Section: Introductionmentioning

confidence: 99%

Assessment of D-dimer for ruling out peripherally inserted central catheter-associated upper extremity venous thrombosis: a diagnostic accuracy study

Liu¹,

He²,

Zeng³

et al. 2020

Preprint

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Background: With the extensive use of peripherally inserted central catheter (PICC), PICC-associated venous thrombosis (VT) has become one of the most important complications in the hospital. To reduce unnecessary Color Doppler Ultrasound (CDU) or imaging tests, D-dimer values are usually used to exclude VT for patients with low VT risk. There is little evidence for the usefulness of the D-dimer level as an independent diagnostic marker for excluding PICC-associated VT.Aims: To examine the effectiveness of D-dimer values to be used as an independent diagnostic marker for excluding PICC-associated Upper Extremity Venous Thrombosis(UEVT).Methods:Records were reviewed for 281 patients who underwent PICC insertion over the two years period in Xiangya Hospital Central South University.The patients were categorized into the UEVT unlikely group (<2 points) and the UEVT likely group (≥2 points) according to the Constans Clinical Decision Score( Constans score) post PICC insertion, before extubation. After the score was determined, the patients underwent a D-dimer test and CDU within 7 days after D-dimer test.Results: Among 281 patients, 180 patients (36%, 95%CI:30.6%-41.8%) had negative D-dimer results, 39 of 180 patients had VT despite having a negative D-dimer result, resulting in a failure rate of 21.7% (95% CI: 16.3–28.3%).The NPV of PICC-associated VT in the cancer group (80.0%,95% CI: 73.2–85.4%) was higher than that of the non-cancer group (60.0%,95% CI: 35.7–80.2%). The NPV of PICC-associated DVT(Deep Venous Thrombosis) (84.9%,95% CI: 78.7–89.6%) was lower than that of the PICC-associated SVT(Superficial Venous Thrombosis) (91.0% ,95% CI: 85.4–94.6%).Conclusion: The D-dimer levels maybe should not be used as a diagnostic index to rule out PICC-associated VT to avoid missed diagnosis of PICC-related VT, which may cause adverse consequences.

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Prognostic value of red blood cell distribution width and D‐Dimer in diffuse large B‐cell lymphoma: Systematic review and meta‐analysis

Rahchamani,

Sedghi,

Hakimi

et al. 2023

Cancer Reports

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BackgroundThe significant role of red blood cell distribution width (RDW) and D‐Dimer as prognostic factors in patients with some blood malignancies has been reported recently.AimWe designed and performed a meta‐analysis to investigate the prognostic roles of RDW and D‐Dimer in subjects with diffuse large B‐cell lymphoma (DLBCL).Materials and MethodsWe systematically reviewed PubMed‐Medline, SCOPUS, EMBASE, Web of Science Core Collection, and Google Scholar up to the present to look for publications on prognostic effects of RDW and D‐Dimer in DLBCL patients. For investigation of the associations between RDW and D‐Dimer with the overall survival (OS) and progression‐free survival (PFS) of the DLBCL cases, hazard ratio (HR) with 95% confidence intervals (CIs) was used.ResultsWe included 13 eligible studies in the present meta‐analysis. The results of pooled analysis showed that increased levels of RDW was related to poor OS (HR = 2.01, 95% CI: 1.62–2.48, p value <.01, I2 = 0%) and poor PFS (HR = 1.52, 95% CI: 1.24–1.85, p value <.01, I2 = 16%) among the DLBCL patients. Similarly, a significant relationship was found between increased D‐Dimer and poor OS (HR = 2.30, 95% CI: 1.03–5.14, p value <.05, I2 = 95%) of the DLBCL patients as well. In addition, there was no significant heterogeneity in OS (p value H = 0.65) and PFS (p value H = 0.31) related to RDW among studies included in the meta‐analysis.ConclusionOur finding clearly confirmed that elevated RDW levels and D‐Dimer were associated with adverse OS and PFS in DLBCL.

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Safety of D‐dimer testing as a stand‐alone test for the exclusion of deep vein thrombosis as compared with other strategies

Cited by 25 publications

References 34 publications

Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

Assessment of D-dimer for ruling out peripherally inserted central catheter-associated upper extremity venous thrombosis: a diagnostic accuracy study

Prognostic value of red blood cell distribution width and D‐Dimer in diffuse large B‐cell lymphoma: Systematic review and meta‐analysis

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