D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

Elias, Antoine; Aptel, Isabelle; Huc, B; Chalé, Jean-Jacques; Nguyen, Françoise; Cambus, Jean-Pierre; Boccalón, H; Boneu, B

doi:10.1055/s-0038-1650615

Cited by 77 publications

(54 citation statements)

References 11 publications

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“…Our review found results for the quantitative assays frequently reported at different cut points. In several studies the cut point was not determined a priori but instead was chosen retrospectively to maximize the sensitivity of the assay (19,(25)(26)(27).…”

Section: Differences Among D-dimer Assaysmentioning

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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Section: Differences Among D-dimer Assaysmentioning

confidence: 99%

D-Dimer Testing for Deep Venous Thrombosis: A Metaanalysis

Schectman²,

et al. 2004

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“…On the other hand, DD is able to rule out venous thromboembolism (VTE) because of its high sensitivity to the presence of acute PE and/or DVT [12±14]. Various assay techniques are available, of which the most reliable is the enzyme-linked immunosorbent assay (ELISA) technique [15,16] which now exists as a rapid, automated test that is more suited for emergency use [17].…”

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confidence: 99%

p38 Mitogen-activated protein kinase regulates IL-8 expression in human pulmonary vascular endothelial cells

Hashimoto¹,

Matsumoto²,

Gon³

et al. 1999

Eur Respir J

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The effectiveness of new diagnostic tools for suspected pulmonary embolism (PE), such as clinical probability assessment, plasma D-dimer (DD) measurement and lower limb venous compression ultrasonography (US), has not been specifically studied in patients with a suspected PE occurring during hospital stay.This study applied a sequential, decision analysis-based strategy adding these instruments to a ventilation/perfusion lung scan in a cohort of 114 consecutive inpatients clinically suspected of PE in order to establish in how many patients a pulmonary angiogram could thereby be avoided.A definitive diagnosis could be established by the noninvasive protocol in 61% of these patients: normal/near-normal lung scan, 14%; high probability lung scan, 19%; clinical probability combined with lung scan result, 18%; and US, 8%. Specificity of DD was only 7% and contributed to the exclusion of PE in only two patients. Pulmonary angiography was required in 39% of patients. The 3-month thromboembolic risk in patients in whom PE was excluded by the diagnostic process was 0% (95% confidence interval 0±4.9%).In conclusion, a noninvasive work-up for suspected pulmonary embolism is effective in hospitalized patients, allowing to forego angiography in 61% of them, and it appears to be safe, although this should be further investigated. In contrast to outpatients, D-dimer measurement appears to be useless in hospitalized patients. Eur Respir J 1999; 13: 1365±1370.

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“…DD and FDP were also measured by LIA, whereas TAT and PIC were measured by enzyme immunoassay (EIA), and the precise methods are also described elsewhere. 16,17 Analyses and statistics Coagulation/¢brinolysis markers were measured for samples obtained from pregnant women, and median values in each pregnant period were compared and analysed using Mann--Whitney U-test. Correlation analysis between FMC and DD was performed using Spearman's rank correlation analysis.…”

Section: Coagulation/fibrinolysis Markersmentioning

confidence: 99%