Document Detail

The place of D-dimer testing in an integrated approach of patients suspected of pulmonary embolism.
MedLine Citation:
PMID:  9763359     Owner:  NLM     Status:  MEDLINE    
When a patient is suspected of having pulmonary embolism (PE), the first procedure performed in most institutions is lung scintigraphy. Here we propose an alternative diagnostic strategy based on the following sequential combination of procedures: clinical assessment, D-dimer measurement, ultrasonography of lower limbs, and lung scan. This integrated approach may rule out PE in the majority of outpatients suspected of PE and permits district hospitals without lung-scan facilities to manage approximately 50% of outpatients without referral. D-dimer alone will exclude PE in about 30% of patients at low cost. This stepwise strategy is especially useful because only 20-35% of patients suspected of PE really have the disease. Thus, in the majority of patients, ruling out the disease has replaced ruling in the disease.
P de Moerloose; J J Michiels; H Bounameaux
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in thrombosis and hemostasis     Volume:  24     ISSN:  0094-6176     ISO Abbreviation:  Semin. Thromb. Hemost.     Publication Date:  1998  
Date Detail:
Created Date:  1998-12-10     Completed Date:  1998-12-10     Revised Date:  2006-03-07    
Medline Journal Info:
Nlm Unique ID:  0431155     Medline TA:  Semin Thromb Hemost     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  409-12     Citation Subset:  IM    
Division of Angiology and Haemostasis, University of Geneva, Switzerland.
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MeSH Terms
Cost-Benefit Analysis
Fibrin Fibrinogen Degradation Products / analysis*
Leg / blood supply
Predictive Value of Tests
Pulmonary Embolism / blood,  diagnosis*
Veins / ultrasonography
Reg. No./Substance:
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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