| Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study. | |
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MedLine Citation:
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PMID: 15886818 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1-3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans. |
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Authors:
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Antoine Elias; Alain Cazanave; Marie Elias; Valérie Chabbert; Henri Juchet; Hélène Paradis; Philippe Carrière; Françoise Nguyen; Alain Didier; Michel Galinier; Cyrille Colin; Dominique Lauque; Francis Joffre; Hervé Rousseau |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Thrombosis and haemostasis Volume: 93 ISSN: 0340-6245 ISO Abbreviation: Thromb. Haemost. Publication Date: 2005 May |
Date Detail:
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Created Date: 2005-05-11 Completed Date: 2005-08-19 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7608063 Medline TA: Thromb Haemost Country: Germany |
Other Details:
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Languages: eng Pagination: 982-8 Citation Subset: IM |
Affiliation:
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Department of Vascular Medicine, Rangueil University Hospital Centre, Toulouse, France. elias.a@chu-toulouse.fr |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Anticoagulants / therapeutic use Enzyme-Linked Immunosorbent Assay Female Fibrin Fibrinogen Degradation Products / biosynthesis* Follow-Up Studies Humans Lower Extremity / blood supply Male Middle Aged Prospective Studies Pulmonary Artery / pathology* Pulmonary Embolism / blood*, diagnosis* Reproducibility of Results Thromboembolism / diagnosis Thrombosis / diagnosis Time Factors Tomography, Spiral Computed / methods* Treatment Outcome Veins / ultrasonography* Venous Thrombosis / diagnosis |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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