Clinical Probability and D-dimer Testing: How Should We Use Them in Clinical Practice?

Abstract

Venous thromboembolism (VTE) is extraordinarily common and is a major cause of morbidity and mortality. However, accurate and timely diagnosis of VTE is confounded by its kaleidoscopic presentation. Clinical prediction rules (CPRs) and D-dimer testing have both been increasingly employed to clarify the complex decision making required in such cases. Formal clinical pretest probability now serves as the root of algorithms for the diagnosis of DVT and PE. A low pretest probability of VTE plus a negative D dimer can be combined in a bayesian fashion to effectively exclude the diagnosis of VTE. The evidence for this strategy is strongest in younger outpatients with no associated comorbidities, no prior history of VTE, and a short duration of symptoms.

Serum D-Dimer Levels to Evaluate the Risk for Arterial Thromboembolism After Intravitreal Injection of Bevacizumab and Ranibizumab

“…However, a number of previous studies demonstrated that D-dimer levels are associated with thromboembolism risk. [14][15][16][17][18]20 We are continuing to follow the patients in this study to evaluate thromboembolic events. Another limitation is the study design that means a nonrandomized design, no clinical trial, and a small number of cases.…”

“…Measurement of D-dimer levels is a gold standard for diagnosing thrombosis and identifying increased risk of thrombotic events. [15][16][17][18][19] Elevated serum Ddimer levels indicate a high risk of thrombosis. 20 Many long-term prospective studies have demonstrated an association between D-dimer and thromboembolism or coronary heart disease.…”

Air travel-related symptomatic deep venous thrombosis in cruise ship passengers

“…In the 3-risk group model, patients with a score of 0 or less are considered low risk patients, the score of 1-2 presents moderate risk, and the score of 3 or more is classified as high risk, with 5%, 17% and 53% probability of DVT respectively. In the more frequently used 2-risk group evaluation, patients are stratified as DVT unlikely (the Wells score < 2) or DVT likely (the Wells score ≥ 2) where probability of DVT is 6% and 28% respectively [14,15]. By combining this score with the results of a highly sensitive D-dimer assay and proximal leg vein ultrasound scan further evaluation is possible [16].…”

Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management

“…To assist with routine clinical assessment and the clinical Gestalt (i.e., unstructured estimate of the likelihood for PE), prediction rules have been developed that are able to more precisely quantify the pre-test probability of PE and help guide the diagnostic process and triaging of patients with suspected PE. Several pre-test probability scores have been studied, including the Wells and modified Wells score, 20,21 the revised Geneva score, 22 and the pulmonary embolism rule out criteria (PERC) 23 (►Tables 1-3).…”