Negative <scp>d</scp>-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial

Rathbun, Suman; Whitsett, Thomas L.; Raskob, Gary E.

doi:10.7326/0003-4819-141-11-200412070-00007

Cited by 73 publications

(52 citation statements)

References 25 publications

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“…It ensues from these findings that DD should only be ordered for patients in whom DVT is deemed unlikely, since DD results do not alter the diagnostic approach in the rest. The number of patients enrolled is limited but close to that reported by Rathbun et al [5] assuming individuals on warfarin would not have been considered; prevalence of DVT in our series is higher (44.8 vs. 33%), but exclusion of patients on OAT with lower confirmation rates (about 13% [13]) might partly justify these differences.…”

Section: Discussionsupporting

confidence: 76%

“…Some 15% of patients (24.6% of this later clinical probability group) could be safely discharged without the need of any diagnostic tests; the follow-up period was uneventful in all of them. This proportion is clearly lower to that reported by Rathbun et al [5] (45%); even if patients using oral anticoagulants had been excluded it would have been 36%. To a good extent the remarkably higher mean age of our series of patients (71 vs. 55) might be responsible for these differences, since DD levels tend to increase with aging [14].…”

Section: Discussioncontrasting

confidence: 71%

“…Our study differs in its design from that by Rathbun et al [5] in several aspects. First, both inpatients and individuals on oral anticoagulant treatment (OAT) were considered ineligible, given the lower diagnostic value of DD in those subsets of patients [13]; patients on warfarin made up 46% of subjects enrolled in the study mentioned above, but a high rate of false negative DD results in this setting has been reported [12].…”

Section: Discussionmentioning

confidence: 72%

“…A single recently published trial concluded that a negative D-dimer (DD) test alone is a useful tool for ruling out acute recurrent DVT [5]. Diagnostic algorithms using combined DD and clinical evaluation have proved to be useful and safe for exclusion of DVT in outpatients with a suspected first episode of venous thrombosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. 82:41-44, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Aguilar¹,

Villar²

2006

American J Hematol

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“…Five prospective cohort management studies have reported results for strategies involving D-dimer testing in patients with suspected recurrent DVT. 19,[47][48][49][50] In a randomized trial of 1,096 outpatients with suspected DVT, of whom 102 had prior VTE, 19 the combination of an unlikely pretest probability (using the modified Wells model, which includes a history of previous VTE as one of the factors used to determine clinical probability) and negative D-dimer (either moderate or high sensitivity) had a frequency of VTE during 3-month follow-up of 0.9% (95% CI, 0.3 to 3.3%); however, results for the 102 patients with suspected recurrence were not presented separately. In two studies in which a negative sensitive D-dimer was used either in combination with an unlikely pretest probability using the modified Wells model 48 or a compression ultrasound at presentation that was either normal or showed an increase in residual diameter of less than 4 mm 49 to exclude recurrence, no patients experienced VTE during 3 months of follow-up.…”

Section: • Myocardial Infarctionmentioning

confidence: 99%

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Bates

2012

Semin Thromb Hemost

103

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).D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. This specific cross-linked fibrin degradation product is formed through the sequential action thrombin, activated factor XIII (FXIIIa), and plasmin (►Fig. 1). 1-3 First, thrombin, generated when coagulation is activated, converts fibrinogen to fibrin and activates FXIII. Second, FXIIIa covalently crosslinks D-domains in adjacent fibrin monomers. Third, plasmin (formed on the fibrin surface by plasminogen activation) cleaves substrate fibrin at specific sites, and when it cleaves fibrin cross-linked by FXIIIa, it generates D-dimer. D-dimer is cleared through the kidneys and the reticuloendothelial system and has a plasma half-life of approximately 8 hours. 4 Low levels of D-dimer can be found circulating under normal physiologic conditions, while pathologically elevated levels can be found in any condition associated with enhanced fibrin formation and fibrinolysis (►Table 1). 1-3 The utility of D-dimer measurement has been evaluated in several clinical situations; however, the D-dimer assays have been best validated for the exclusion of venous thromboembolism (VTE) and the diagnosis and monitoring of disseminated intravascular coagulation (DIC). This article will review the available evidence for the utilization of D-dimer antigen measurement in the management of thrombotic and bleeding disorders. Measurement of D-DimerThe presence of D-dimer in plasma can be detected using monoclonal antibodies that recognize an epitope present in FXIIIa-cross-linked fragment D-domain of fibrin but not in fibrinogen degradation products or noncross-linked fibrin degradation products. Many different D-dimer assays have been developed and marketed. All of these tests rely on the use of monoclonal antibodies to detect D-dimer molecules. In general, three techniques are available to assay D-dimer (►Fig. 2). 1-3 These are (1) enzyme-linked immunosorbent assays (ELISAs) that rely on antibody capture and labeling of D-dimer; (2) a whole-blood agglutination assay (SimpliRED, Siemens Healthcare Diagnostics, Newcastle, DE), that uses a bispecific antibody conjugate with binding sites for both D-dimer and a red cell antigen and is performed on whole blood; (3) latex agglutination assays that also use bispecific antibodies with specificity for the latex particle and D-dimer antigen. Earlier latex agglutination assays for D-dimer were qualitative or semiquantitative; however, newer automated, quantitative D-dimer assays (which are immunoturbidometric assays) are performed on routine, automated coagulation instruments. It is important to recognize that results are not comparable between different assays, even between those of similar formats. Potential reasons for the lack of comparable results are listed in ►Table 2. Numeric results of D-dimerAbstract D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. The utility of D-dimer measur...

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Value of D-Dimer Testing for the Exclusion of Pulmonary Embolism in Patients With Previous Venous Thromboembolism

Gal¹,

Righini²,

Roy³

et al. 2006

Arch Intern Med

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Negative d-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial

Abstract: Measurement of plasma d-dimer by using the automated quantitative assay STA-Liatest D-di seems to provide a simple method for excluding acute recurrent DVT in symptomatic patients.

Cited by 73 publications

References 25 publications

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Value of D-Dimer Testing for the Exclusion of Pulmonary Embolism in Patients With Previous Venous Thromboembolism

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