The role of plasma D‐dimer concentration in the exclusion of pulmonary embolism

Abstract

Summary.Objective. To determine the role of four ELISA D-dimer assays in the exclusion of pulmonary embolism.Design. Blinded comparison using pulmonary angiography and/or lung scintigraphy as a reference method.Setting. A secondary and tertiary referral centre. Patients and methods. Consecutive patients with suspected pulmonary embolism underwent lung scintigraphy, followed by angiography if a non-diagnostic result was obtained. Comorbid conditions resulting in elevated plasma D-dimer levels were defined a priori. Cut-off levels for 100% sensitivity were determined. A decision-analytic model was used to determine effectiveness and costs in the management pulmonary embolism.Main outcome measures. The exclusion efficacy of the various assays at a sensitivity of 100%, and cost-effectiveness.Results. A total of 179 patients were included (78 inpatients and 101 outpatients; 74 patients had comorbid conditions). Pulmonary embolismcould be adequately excluded in between 8% and18%of allpatients,andinbetween 3% and7% and11% and 27% of inpatients and outpatients,respectively, depending on the assay used. D-dimer assays could exclude pulmonary embolism in <5% of patients with comorbid conditions, whereas this increased to 14-32% in outpatients without comorbid conditions. A cost-effectiveness analysis showed a cost reduction of 10% at a specificity of 30%, largely due to a 28% decrease in angiography requirements. Furthermore, for every 2% decrease in sensitivity, one per 1000 evaluated patientswoulddieasaresultofinadequatelytreatedpulmonary embolism.Conclusion. D-dimer ELISA assays may have a role in the exclusion of pulmonary embolism in symptomaticoutpatients, where the application may reduce angiography by 30% and costs by 10%.

Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients

“…21,22 The reference ELISA (Asserachrom D-Di) was found to have a negative predictive value of 100%, which is in keeping with earlier studies. 8,9 Correlations were strong between the reference test and the STALiatest D-Di. In three patients, none of whom had DVT, a discrepancy was noted between the D-Di levels obtained using the reference Asserachrom D-Di test and the STA Liatest D-Di test.…”

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

“…D-dimer levels above the cutoff that excludes thrombosis have been documented in absence of thrombosis in the elderly and in patients with numerous other conditions including infections, cancer, coronary, cerebral and peripheral arterial vascular disease, heart failure, rheumatologic diseases, surgery, trauma burns, and pregnancy. [18][19][20][21] Van Beek et al 22 and Miron et al 23 demonstrated that d-dimer testing was not useful in hospitalized patients. Kabrhel et al 24 reported similar results in an Emergency Department cohort and concluded that d-dimer testing increased the percent of patients who were investigated for PE and the percent that were sent for pulmonary vascular imaging without increasing the percent of patients diagnosed as having a PE.…”

Accuracy of Hysteroscopy in the Diagnosis of Endometrial Cancer and Hyperplasia

“…To explore for clinical sources of heterogeneity, we defined the potential explanatory variables a priori. 37 In view of the potential influence of spectrum variability, 38,39 we considered menopausal status and setting to be important. In addition, we planned to examine the impact of study quality on estimation of accuracy according to individual quality items (patient selection, reference standard, completeness of verification, and blinding) and also according to an overall quality level (1-5) incorporating these items.…”