The negative predictive value of D‐dimer on the risk of recurrent venous thromboembolism in patients with multiple previous events: A prospective cohort study (the PROLONG PLUS study)

Ageno, Walter; Cosmi, Benilde; Ghirarduzzi, Angelo; Santoro, Rita; Bucherini, Eugenio; Poli, Daniela; Prisco, Domenico; Alatri, Adriano; Pengo, Vittorio; Galli, Luca; Dentali, Francesco; Palareti, Gualtiero

doi:10.1002/ajh.23198

Cited by 8 publications

(4 citation statements)

References 18 publications

(14 reference statements)

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“…The PROLONG PLUS study concluded that DD could identify patients with history of previous VTE at low risk of recurrence. (22) Other researchers have found persistently high DD levels to be an independent predictor of recurrent VTE (hazard ratio, 4.10; 95% CI, 1.61–10.39; P = 0.003). (23)…”

Section: Discussionmentioning

confidence: 95%

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: 95%

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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“…To identify patients at high risk, measurement of D-dimer (DD), a biomarker that indicates ongoing coagulation activation and fibrin degradation, at the end of VKA therapy has been suggested. Elevated DD levels were shown to correlate with the risk of VTE recurrence, especially if values increase within 4 weeks after VKA discontinuation [5,[7][8][9]. Therefore, DD monitoring at the end of VKA treatment is part of the clinical routine in many VTE centres around the world.…”

Section: Introductionmentioning

confidence: 97%

Coagulation activation after discontinuation of VTE treatment with different oral anticoagulants and impact on 12-month clinical outcomes

Beyer‐Westendorf

Gehrisch

Stange

et al. 2015

Thrombosis Research

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“…The monitoring of patients with a provoked VTE by transient risk factors is not required after the finalization of the primary treatment due to the improbable risk of recurrence of VTE in these individuals 2179 . Is not clear if the same condition in provoked VTE by chronic risk factors such as active cancer, inflammatory bowel disease, autoimmune disorders, chronic infections, and chronic immobility, will necessarily need extended anticoagulation, and with that, closer monitoring of the VTE [2188][2189][2190][2191][2192] . The third condition would be an unprovoked VTE.…”

Section: Jean-yves Jennymentioning

confidence: 99%

“…Serum D-dimer levels are easily tested and have proven to be effective in the assessment of residual thrombosis after VTE provoked by orthopaedic 2190 and non-orthopaedic procedures [2193][2194][2195] . Despite having low specificity, they are considered useful for excluding diagnoses due to their high negative predictive values for DVT and PE 2188,2196,2197 . However, by themselves they are not an infallible tool and must be accompanied by imaging studies to confirm the presence of VTE.…”

Section: Jean-yves Jennymentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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The negative predictive value of D‐dimer on the risk of recurrent venous thromboembolism in patients with multiple previous events: A prospective cohort study (the PROLONG PLUS study)

Cited by 8 publications

References 18 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

Coagulation activation after discontinuation of VTE treatment with different oral anticoagulants and impact on 12-month clinical outcomes

Recommendations from the ICM-VTE: General

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