| The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study. | |
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MedLine Citation:
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PMID: 10613639 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: D-dimer assays have a potential to rule out pulmonary embolism in case of a normal test result. We studied the clinical utility of incorporating the SimpliRED D-dimer test result and clinical probability in the routine diagnostic work-up of patients with suspected acute pulmonary embolism. METHODS: In a prospective management study 245 consecutive patients, hospitalised as well as outpatients, were included. A SimpliRED D-dimer test and perfusion/(ventilation) scintigraphy were obtained in all patients, whereas clinical probability was determined in the subgroup of patients with a non-diagnostic scan and normal D-dimer result. A diagnostic algorithm determined the necessity for further testing and decisions about treatment. All patients were followed up for 3 months. RESULTS: In 54 patients (22%) with a normal lung scan and 50 patients (21%) with a high probability lung scan, antithrombotic therapy was withheld or started respectively, irrespective of the D-dimer result. A non-diagnostic lung scan was found in 137 (56%) patients, of whom 70 patients had an abnormal D-dimer test, in whom further testing was ordered. Of the remaining 67 patients with a non-diagnostic lung scan and normal D-dimer test 8 patients had a high clinical probability, and the subsequent ultrasonography and pulmonary angiography yielded pulmonary emboli in 1 patient. In the remaining 66 patients, pulmonary embolism was considered to be absent and antithrombotic treatment was stopped/withheld. During follow-up of these patients only one patient experienced a possible venous thromboembolic event (failure rate 1,5%; 95% CI 0-8%). The SimpliRED D-dimer was normal in 6 of 61 patients with proven pulmonary embolism (sensitivity 90%; 95% CI 80-96%). CONCLUSION: Our findings suggest that it is safe to withhold anticoagulant therapy in those patients with a non-diagnostic lung scan, a normal SimpliRED D-dimer test result, and without a high clinical probability. This results in a substantial decreased need for ultrasonography and pulmonary angiography. The SimpliRED should not be used in isolation to exclude pulmonary embolism. |
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Authors:
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M R de Groot; M van Marwijk Kooy; J G Pouwels; A H Engelage; B F Kuipers; H R Büller |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Thrombosis and haemostasis Volume: 82 ISSN: 0340-6245 ISO Abbreviation: Thromb. Haemost. Publication Date: 1999 Dec |
Date Detail:
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Created Date: 2000-01-31 Completed Date: 2000-01-31 Revised Date: 2004-11-17 |
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: 1588-92 Citation Subset: IM |
Affiliation:
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Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands. m.r.degroot@amc.uva.nl |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Coagulation Tests Female Fibrin Fibrinogen Degradation Products / analysis* Humans Male Middle Aged Predictive Value of Tests Prospective Studies Pulmonary Embolism / blood, diagnosis*, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
| Comments/Corrections | |
Comment In:
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Thromb Haemost. 2000 Feb;83(2):180-1
[PMID:
10739368
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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