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The use of the D-dimer test in combination with non-invasive testing versus serial non-invasive testing alone for the diagnosis of deep-vein thrombosis.
Thromb Haemost. 1992 May 04; 67(5):510-3.TH

Abstract

We studied the usefulness of the determination of plasma D-dimer levels (using an ELISA) in combination with non-invasive testing with impedance plethysmography (IPG) or real-time ultrasonography (US) for the diagnosis of deep-vein thrombosis (DVT), in outpatients with clinically suspected DVT. This combined approach was compared to serial non-invasive testing alone in these patients. The sensitivity of a positive D-dimer test (greater than 300 micrograms/l) for the presence of DVT was 100% (70/70 patients; 95% C.I.: 95-100%), whereas the specificity was 29% (69/239 patients; 95% C.I.: 23-34%). The proportion of patients in which a definitive decision about the presence or absence of DVT could be made on the day of referral, was calculated for both approaches. When applying the combined approach, in 42% of all referred patients the diagnosis of DVT could either be established or refuted on entry, as opposed to only 19% of patients using serial non-invasive testing alone. Also, the costs per DVT diagnosed were calculated for the two diagnostic approaches. For the diagnosis of DVT the costs using serial IPG were comparable to the costs using the combination of IPG and the D-dimer test. The same conclusion holds for the comparison of serial US with the combination of US and D-dimer testing. We conclude that for the diagnosis of DVT in symptomatic outpatients the combination of non-invasive testing with the D-dimer test might be preferred over serial non-invasive testing alone, although the safety of such an approach remains to be established in future management studies.

Authors+Show Affiliations

Heijboer H
Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands.
Ginsberg JS
No affiliation info available
Büller HR
No affiliation info available
Lensing AW
No affiliation info available
Colly LP
No affiliation info available
Wouter ten Cate J
No affiliation info available

MeSH

Cost-Benefit AnalysisEnzyme-Linked Immunosorbent AssayFibrin Fibrinogen Degradation ProductsHumansPhlebographyPlethysmography, ImpedancePredictive Value of TestsSensitivity and SpecificityThrombophlebitisUltrasonography

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

1519209

Citation

Heijboer, H, et al. "The Use of the D-dimer Test in Combination With Non-invasive Testing Versus Serial Non-invasive Testing Alone for the Diagnosis of Deep-vein Thrombosis." Thrombosis and Haemostasis, vol. 67, no. 5, 1992, pp. 510-3.
Heijboer H, Ginsberg JS, Büller HR, et al. The use of the D-dimer test in combination with non-invasive testing versus serial non-invasive testing alone for the diagnosis of deep-vein thrombosis. Thromb Haemost. 1992;67(5):510-3.
Heijboer, H., Ginsberg, J. S., Büller, H. R., Lensing, A. W., Colly, L. P., & Wouter ten Cate, J. (1992). The use of the D-dimer test in combination with non-invasive testing versus serial non-invasive testing alone for the diagnosis of deep-vein thrombosis. Thrombosis and Haemostasis, 67(5), 510-3.
Heijboer H, et al. The Use of the D-dimer Test in Combination With Non-invasive Testing Versus Serial Non-invasive Testing Alone for the Diagnosis of Deep-vein Thrombosis. Thromb Haemost. 1992 May 4;67(5):510-3. PubMed PMID: 1519209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of the D-dimer test in combination with non-invasive testing versus serial non-invasive testing alone for the diagnosis of deep-vein thrombosis. AU - Heijboer,H, AU - Ginsberg,J S, AU - Büller,H R, AU - Lensing,A W, AU - Colly,L P, AU - Wouter ten Cate,J, PY - 1992/5/4/pubmed PY - 1992/5/4/medline PY - 1992/5/4/entrez SP - 510 EP - 3 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 67 IS - 5 N2 - We studied the usefulness of the determination of plasma D-dimer levels (using an ELISA) in combination with non-invasive testing with impedance plethysmography (IPG) or real-time ultrasonography (US) for the diagnosis of deep-vein thrombosis (DVT), in outpatients with clinically suspected DVT. This combined approach was compared to serial non-invasive testing alone in these patients. The sensitivity of a positive D-dimer test (greater than 300 micrograms/l) for the presence of DVT was 100% (70/70 patients; 95% C.I.: 95-100%), whereas the specificity was 29% (69/239 patients; 95% C.I.: 23-34%). The proportion of patients in which a definitive decision about the presence or absence of DVT could be made on the day of referral, was calculated for both approaches. When applying the combined approach, in 42% of all referred patients the diagnosis of DVT could either be established or refuted on entry, as opposed to only 19% of patients using serial non-invasive testing alone. Also, the costs per DVT diagnosed were calculated for the two diagnostic approaches. For the diagnosis of DVT the costs using serial IPG were comparable to the costs using the combination of IPG and the D-dimer test. The same conclusion holds for the comparison of serial US with the combination of US and D-dimer testing. We conclude that for the diagnosis of DVT in symptomatic outpatients the combination of non-invasive testing with the D-dimer test might be preferred over serial non-invasive testing alone, although the safety of such an approach remains to be established in future management studies. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/1519209/The_use_of_the_D_dimer_test_in_combination_with_non_invasive_testing_versus_serial_non_invasive_testing_alone_for_the_diagnosis_of_deep_vein_thrombosis_ DB - PRIME DP - Unbound Medicine ER -