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The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study.
Thromb Haemost. 1999 Dec; 82(6):1588-92.TH

Abstract

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+Show Affiliations

Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands. m.r.degroot@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10613639

Citation

de Groot, M R., et al. "The Use of a Rapid D-dimer Blood Test in the Diagnostic Work-up for Pulmonary Embolism: a Management Study." Thrombosis and Haemostasis, vol. 82, no. 6, 1999, pp. 1588-92.
de Groot MR, van Marwijk Kooy M, Pouwels JG, et al. The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study. Thromb Haemost. 1999;82(6):1588-92.
de Groot, M. R., van Marwijk Kooy, M., Pouwels, J. G., Engelage, A. H., Kuipers, B. F., & Büller, H. R. (1999). The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study. Thrombosis and Haemostasis, 82(6), 1588-92.
de Groot MR, et al. The Use of a Rapid D-dimer Blood Test in the Diagnostic Work-up for Pulmonary Embolism: a Management Study. Thromb Haemost. 1999;82(6):1588-92. PubMed PMID: 10613639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study. AU - de Groot,M R, AU - van Marwijk Kooy,M, AU - Pouwels,J G, AU - Engelage,A H, AU - Kuipers,B F, AU - Büller,H R, PY - 1999/12/29/pubmed PY - 1999/12/29/medline PY - 1999/12/29/entrez SP - 1588 EP - 92 JF - Thrombosis and haemostasis JO - Thromb. Haemost. VL - 82 IS - 6 N2 - 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. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/10613639/The_use_of_a_rapid_D_dimer_blood_test_in_the_diagnostic_work_up_for_pulmonary_embolism:_a_management_study_ L2 - http://www.diseaseinfosearch.org/result/2504 DB - PRIME DP - Unbound Medicine ER -