Validity of D‐dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays

Larsen, Torben Bjerregaard; Stoffersen, Erik; Christensen, C S; Laursen, Birgitte Schantz

doi:10.1046/j.1365-2796.2002.00998.x

Cited by 33 publications

(20 citation statements)

References 20 publications

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“…The authors state that the sensitivity of the assay was 98% (95% confidence interval, 90%-100%) and the negative predictive value (NPV) was 99% (95% confidence interval, 95%-100%). This is in contrast to a recent article by Larsen and colleagues, 2 who assessed the reliability of the same D-dimer assay (Table). Using the discriminant values suggested by the manufacturer, the VIDAS kit has a sensitivity of 90%, a specificity of 42%, and an NPV of 85%.…”

contrasting

confidence: 62%

D-Dimer Tests for Assessment of Patients With Suspected Pulmonary Embolism

Caine¹,

Lip²

2003

Arch Intern Med

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mote and recent history of the naming of medical specialties and the continued disagreement concerning the desirability of even the term internal medicine, I would think that medical journals would be in the forefront of suggesting the use of existing terms that are clear and unambiguous. Furthermore, I would think that most children of the pertinent age group would rather make a visit to their family ephebiatrician than to their adolescent medicine doctor. This is in contrast to a recent article by Larsen and colleagues, 2 who assessed the reliability of the same D-dimer assay (Table). Using the discriminant values suggested by the manufacturer, the VIDAS kit has a sensitivity of 90%, a specificity of 42%, and an NPV of 85%. The reason for this discrepancy is unclear. N. Ralph Frankel, MDHowever, the article by Kruip et al 1 raised some excellent points. Accurate diagnosis of deep vein thrombosis (DVT) and correct therapy are of vital importance to reduce the risk of long-term morbidity or mortality due to pulmonary embolism. As clinical signs and symptoms are nonspecific, DVT must be confirmed by objective methods.3 At present, most hospitals use the noninvasive compression ultrasonography as the gold standard, with high sensitivity and specificity for proximal DVT, whereas the sensitivity for calf vein thrombosis is lower. [4][5][6][7] Several strategies for the exclusion of DVT have been suggested elsewhere.8 One study used the standard VIDAS D-dimer assay as the initial screening in 474 patients with suspected DVT, combined with ultrasonography. 9 This combined strategy could demonstrate an NPV of 99.3% in a population with a low prevalence of venous thromboembolism of 23%.Using the reversed strategy, that is, ultrasonography as the initial screening method combined with a D-dimer assay, another study of 476 patients with DVT revealed a prevalence of 27.5% and an NPV of 99.6%. 10This calls for a differential strategy; in cases of low clinical probability, the initial test could be a D-dimer test with a high NPV.11 In cases with a high clinical probability of disease, a test with a high positive predictive value should be chosen, such as ultrasonography.Finally, one should be aware that many systemic disorders can influence levels of D-dimer, and high levels have been reported in diseases as diverse as atrial fibrillation, congestive heart failure, peripheral artery disease, and cancer-indeed, D-dimer has been considered as a useful clinical marker of thrombogenesis and abnormal levels may also have prognostic implications for cardiovascular events.

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contrasting

confidence: 62%

D-Dimer Tests for Assessment of Patients With Suspected Pulmonary Embolism

Caine¹,

Lip²

2003

Arch Intern Med

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“…For other assays, lower specificities were obtained in our study population: Auto Dimer reported sensitivities between 90 and 99% and specificities from 39 to 57% [30,33], and Innovance reported a sensitivity of 99% and a specificity of 39.1% [34].…”

Section: Discussionmentioning

confidence: 99%

Comparison of six D-dimer assays for the detection of clinically suspected deep venous thrombosis of the lower extremities

Boeer

Siegmund²,

Schmidt³

et al. 2009

Blood Coagulation &Amp; Fibrinolysis

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Deep venous thrombosis is a common disease that may lead to life-threatening embolism of the lung as a common complication. Therefore, early diagnosis followed by sufficient treatment is necessary to decrease mortality of this disease. D-dimer testing is established as a standard to rule out deep venous thrombosis in selected patient groups. However, there is no standardization among D-dimer assays, and a periodical comparison of assay performance in a select patient group is indispensable. We evaluated six commonly used D-dimer assays for their assay performance in an outpatient cohort with clinically suspected deep venous thrombosis. Although area under the curve for these assays did not differ significantly (0.83-0.88), differences in sensitivity (90-100%) and specificity (10-40%) of the assays were detected. Alternative cut-offs were established, and these cut-offs could enhance assay performance in some cases. This points to the fact that the manufacturers should more regularly review studies on the performance of their respective assays to widen the data basis for their recommended cut-offs and increase assay performance.

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“…However, recent investigation was less convincing. In one study sensitivity in DVT diagnosis was described to be as low as 63% (38). Our results were also disappointing and prevent us from recommending this assay for routine use.…”

Section: D-dimer Poc Assaysmentioning

confidence: 69%

»Point-of-Care« D-Dimer Testing

Antović¹

2010

Journal of Medical Biochemistry

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Kratak sadr`aj: Odre|ivanje D-dimera omogu}ava efikasno isklju~ivanje venskog tromboembolizima (VTE). Labo ratorijsko testiranje D-dimera prete`no se izvodi u centralizovanim laborato rijama u okviru bolnica, iako se ve}ina pacijenata kod kojih se sumnja na VTE javlja na pregled u ustanove primarne zdravstvene za{tite. Tako|e, skra}enje ukupnog trajanja laboratorijskog testiranja bi znatno pobolj{alo efikasnost u urgentnim centrima. Stoga bi uvo|e -nje brzog »Point of Care (POC)« D-dimer testa koji se lako izvodi, dovelo do pobolj{anja dijagnostike VTE u primarnoj zdravstvenoj za{titi kao i u urgentnim centrima, ali tako|e i u dijagnostici drugih te{kih klini~kih stanja (diseminovana intravaskularna koagulacija (DIK), aneurizma aorte) u kojima je D-dimer povi{en. Ve}ina dostupnih POC D-dimer testova ispunjava kriterijume za brzo i sigurno isklju~ivanje VTE-a. U na{em ispitivanju tri testa (Stratus, Pathfast i Cardiac) pokazala su karakteristike sli~ne D-dimer testu koji je u rutinskoj upotrebi u na{oj laboratoriji (Tinaquant).

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Validity of D‐dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays

Cited by 33 publications

References 20 publications

D-Dimer Tests for Assessment of Patients With Suspected Pulmonary Embolism

D-Dimer Tests for Assessment of Patients With Suspected Pulmonary Embolism

Comparison of six D-dimer assays for the detection of clinically suspected deep venous thrombosis of the lower extremities

»Point-of-Care« D-Dimer Testing

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