Document Detail


The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study.
MedLine Citation:
PMID:  10613639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  82     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-01-31     Completed Date:  2000-01-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  1588-92     Citation Subset:  IM    
Affiliation:
Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands. m.r.degroot@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
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:
0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D
Comments/Corrections
Comment In:
Thromb Haemost. 2000 Feb;83(2):180-1   [PMID:  10739368 ]

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


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