Document Detail


Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy.
MedLine Citation:
PMID:  11943938     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
D-dimer testing is useful for the exclusion of acute venous thromboembolism (VTE). Anticoagulant therapy is expected to reduce D-dimer levels in patients with thrombosis and, consequently, it may not be safe to use D-dimer levels to exclude VTE after anticoagulant therapy has been started. The objectives of this study were to estimate the decrease in D-dimer levels after 24 h of heparin therapy and, applying this estimate to the results of a recent study, to calculate the expected reduction in sensitivity. Using pre-defined criteria, we first performed a literature review to determine whether, and by how much, D-dimer levels decrease within 24 h of starting heparin therapy in patients with acute VTE. Using D-dimer levels that were measured in a prospective study of patients with confirmed deep vein thrombosis and/or pulmonary embolism as baselines, we then determined the change in sensitivity (and specificity) that would result from the fall in D-dimer levels that the literature review suggested would have occurred after 24 h of heparin therapy. On the basis of the literature review, we calculated that mean D-dimer levels decrease by 25%, 24 h after starting heparin therapy in patients with acute VTE. This 25% decrease in D-dimer levels resulted in a decrease in sensitivity from 95.6% (95% confidence interval, 90.0-98.6) to 89.4% (95% confidence interval, 83.7-95.1). There is a decrease in D-dimer levels in patients with acute VTE 24 h after starting heparin therapy that is expected to result in a clinically important drop in sensitivity.
Authors:
F Couturaud; C Kearon; S M Bates; J S Ginsberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  13     ISSN:  0957-5235     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-04-10     Completed Date:  2002-10-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  241-6     Citation Subset:  IM    
Affiliation:
Hamilton Civic Hospitals Research Centre, and McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / pharmacology,  therapeutic use*
Biological Markers
False Negative Reactions
Fibrin Fibrinogen Degradation Products / analysis*
Heparin / pharmacology,  therapeutic use*
Humans
Predictive Value of Tests
Prospective Studies
Pulmonary Embolism / blood,  diagnosis*,  drug therapy
Sensitivity and Specificity
Time Factors
Venous Thrombosis / blood,  diagnosis*,  drug therapy
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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