Application of a bedside whole blood D-dimer assay in the diagnosis of deep vein thrombosis

Brenner, Barry E.; Pery, M; Lanir, Naomi; Jabareen, A; Markel, Arie; Jk, Kaftori; Gaitini, Diana; Rylatt, Dennis B.

doi:10.1097/00001721-199505000-00004

Cited by 46 publications

(20 citation statements)

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“…Other investigators also reported high sensitivity and negative predictive value for this rapid whole blood assay in suspected pulmonary embolism 11 and suspected DVT. 12 In our study, selection bias may have resulted from excluding patients with symptoms exceeding 7 days' duration; however, the time lag between the thrombotic event and diagnostic procedures may result in a false-negative D-dimer result. Therefore, when faced with a clinically suspected DVT showing "old" symptoms, these biologic tests may not be suitable.…”

Section: Discussionmentioning

confidence: 82%

Evaluation of a New Rapid D-Dimer Assay for Clinically Suspected Deep Venous Thrombosis (Liatest D-Dimer)

Escoffre‐Barbe¹,

Oger²,

Leroyer³

et al. 1998

Am J Clin Pathol

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Several studies have evaluated D-dimer, a fragment that is specific for the degradation of fibrin, 1 in patients with clinically suspected d e e p v e n o u s thrombosis (DVT).2 Because of their long half-lives, D-dimers provide a better choice than markers with shorter half-lives (thrombin-antithrombin complexes and prothrombin fragments 1 + 2) in evaluating the DVTs. Two D-dimer techniques are currently available: an e n z y m e l i n k e d -i m m u n o s o r b e n t assay (ELISA) or a latex agglutination assay. In preliminary studies, the ELISA assay has been reported to have very high sensitivity and moderate specificity. ELISA is the more widely used method. However, because it is time consuming, it is not well adapted for emergency testing; in addition, ELISA formatting is not usually suitable for individual testing. Studies involving latex testing for the measurement of Ddimer have frequently reported insufficient sensitivity for the exclusion of DVT. The purpose of the present study was to determine the performance of a new, quantitative and automated rapid D-dimer assay in the diagnosis of s u s p e c t e d DVT in a cohort of patients in whom symptoms had developed within 7 days before admission to the hospital. METHODS PatientsData for all patients with a possible diagnosis of DVT w h o were a d m i t t e d to the D e p a r t m e n t of Pneumology and Internal Medicine were collected prospectively on a register from March 1992 to June 1995. Recent clinical symptoms of DVT (onset less than 7 days) had to be present. The clinical suspicion of DVT occurred before hospitalization, so patients were referred for diagnosis, or during the first clinical 748

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Section: Discussionmentioning

confidence: 82%

Evaluation of a New Rapid D-Dimer Assay for Clinically Suspected Deep Venous Thrombosis (Liatest D-Dimer)

Escoffre‐Barbe¹,

Oger²,

Leroyer³

et al. 1998

Am J Clin Pathol

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“…Only five studies explicitly examined D-dimer assays in patients with no previous history of VTE and not taking anticoagulants. Only one study did not adequately describe methods for independent, blinded test performance and comparison (Standard 2) (14 ). Although all Level 1 studies described the method of patient selection (Standard 3), three did not report simple demographic descriptions of their patients (Standard 4) (14,20,24 ).…”

Section: Resultsmentioning

confidence: 99%

“…Only one study did not adequately describe methods for independent, blinded test performance and comparison (Standard 2) (14 ). Although all Level 1 studies described the method of patient selection (Standard 3), three did not report simple demographic descriptions of their patients (Standard 4) (14,20,24 ). Results of eight studies were stratified by proximal and distal DVT (Standard 5) (19, 20, 25, 28 -30, 34, 36 ).…”

Section: Resultsmentioning

confidence: 99%

D-Dimer Testing for Deep Venous Thrombosis: A Metaanalysis

Schectman²,

et al. 2004

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Background: The use of D-dimer assays as a rule-out test for deep venous thrombosis (DVT) is controversial.To clarify this issue we performed a systematic review of the relevant literature. Methods: We identified eligible studies, using MED-LINE entries from February 1995 through October 2003, supplemented by a review of bibliographies of relevant articles. Studies reporting accuracy evaluations comparing D-dimer test results with lower extremity ultrasound or venography in symptomatic patients with suspected acute DVT were selected for review. Two reviewers critically appraised each study independently according to previously established methodologic standards for diagnostic test research. Those studies judged to be of highest quality were designated Level 1. Results: The 23 Level 1 studies reported data on 21 different D-dimer assays. There was wide variation in assay sensitivity, specificity, and negative predictive values, and major differences in methodology of reviewed studies. A multivariate analysis of assay performance, controlling for sample size, DVT prevalence, reference standard, and patient mix, found few differences among the assays in effect on test performance as measured by diagnostic odds ratio. Increasing prevalence of DVT was associated with poorer test performance (P ‫؍‬ 0.01), whereas the choice of venography as the reference standard was associated with better test performance (P <0.005). Conclusions: Explanations for the wide variation in assay performance include differences in biochemical and technical characteristics of the assays, heterogeneity and small size of patient groups, and bias introduced by choice of reference standards. Assay sensitivity and negative predictive value were frequently <90%, un-

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“…Gosselin 159 Mayer 157 Mayer 157 Kilroy 72 Brenner Lee 149 Gosselin 146 Bozic 71 Wells 128 Brenner 126 Janssen 123 Fiessinger 119 Jacq 117 Wildburger 112 Wells 110 Mauron 108 Lennox 70 Aschwanden 105 Wells 67 Carter 101 Farrell 99 van der Graaf 97 Permpikul 93 Anderson 92 Gosselin 90 Harper 88 Dryjski 64 Shields 61 ten Wolde 83 Pazzagli 209 Liapis 207 Elbaum 206 Richards 52 Nicholas Cooperman 36 Foti 204 Sandler 54 Vacarro 56 Wells 128 Dmochowski 203 Hull 202 Hull 201 Benedict 200 Flanigan 199 Toy 198 Peters 197 O'Donnell 196 Ramchandani 195 Jonker 194 Dauzat…”

Section: Acknowledgementsmentioning

confidence: 99%

Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis

Goodacre

Sampson²,

Stevenson³

et al. 2006

Health Technol Assess

147

119

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Diagnostic algorithms based on a combination of Wells score, D-dimer and ultrasound (with repeat if negative) are feasible at most UK hospitals and are among the most cost-effective. Use of repeat scanning depends on the threshold for willingness to pay for health gain. Further diagnostic testing for patients with a low Wells score and negative D-dimer is unlikely to represent a cost-effective use of resources. Recommendations for research include the evaluation of the costs and outcomes of using the optimal diagnostic algorithms in routine practice, the development and evaluation of algorithms appropriate for specific groups of patients with suspected DVT, such as intravenous drug abusers, pregnant patients and those with previous DVT, the evaluation of the role of plethysmography: interaction with other diagnostic tests, outcome of low-risk patients with negative plethysmography and measurement of the costs of providing plethysmography, and methodological research into the incorporation of meta-analytic data into decision-analytic modelling.

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Application of a bedside whole blood D-dimer assay in the diagnosis of deep vein thrombosis

Cited by 46 publications

References 0 publications

Evaluation of a New Rapid D-Dimer Assay for Clinically Suspected Deep Venous Thrombosis (Liatest D-Dimer)

Evaluation of a New Rapid D-Dimer Assay for Clinically Suspected Deep Venous Thrombosis (Liatest D-Dimer)

D-Dimer Testing for Deep Venous Thrombosis: A Metaanalysis

Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis

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