Combined use of rapid D-dimer testing and estimation of clinical probability in the diagnosis of deep vein thrombosis: systematic review

Abstract

Objective To summarise the evidence supporting the use of rapid d-dimer testing combined with estimation of clinical probability to exclude the diagnosis of deep venous thrombosis among outpatients.

Biomarkers of Atherosclerosis and Acute Coronary Syndromes - A Clinical Perspective

“…Its presence indicates both thrombus formation and subsequent endogenous fibrinolysis, thus confirming that both thrombin and plasmin have been generated (182). It is a sensitive tool for exclusion of venous thromboembolism in the low risk group (183). In ACS plaque rupture or erosion is followed by exposure of the procoagulant lipid core to circulating blood with ensuing thrombus formation.…”

A Cost-effectiveness Analysis of Diagnostic Algorithms of Deep Vein Thrombosis at the Emergency Department

“…Clinical studies and meta analyses show that algorithms based upon Pre-Test Probability (PTP) assessment and D-dimer safely rule out venous thromboembolism (VTE) when the PTP for the disease is assessed as low and D-dimer is negative [1][2][3]. By these means DVT is ruled out in 30-50% of outpatients with suspected DVT and safely obviates the need for further diagnostic testing [4,5].…”

“…Suspected cases of deep vein thrombosis (DVT) are common at emergency departments and they often require extensive and costly diagnostic testing [1][2][3]. Clinical studies and meta analyses show that algorithms based upon Pre-Test Probability (PTP) assessment and D-dimer safely rule out venous thromboembolism (VTE) when the PTP for the disease is assessed as low and D-dimer is negative [1][2][3].…”

Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2009) - Digest Version -

“…D-dimer can be used for patients in whom the possibility of acute-phase DVT is low. 149, 150 Patients with abnormal D-dimer levels should be evaluated with imaging techniques to confirm the diagnosis. Physicians should be aware that the presence of normal D-dimer levels can exclude acute-phase DVT but cannot exclude chronic-phase DVT.…”