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Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability.
J Thromb Haemost. 2004 Aug; 2(8):1256-60.JT

Abstract

Currently, the same D-dimer cut-off point is used to define a positive result for all patients with suspected venous thromboembolism, regardless of their pretest probability. However, use of a relatively high D-dimer cut-off point (lower sensitivity) for those with a low clinical pretest probability, and a low D-dimer cut-off point (higher sensitivity) for those with a high clinical pretest probability, may be preferable. To determine if using three different D-dimer cut-off points according to low, moderate or high clinical pretest probability has greater utility for exclusion of venous thromboembolism than using the same single D-dimer cut-off point in all patients. Data from a previously published study of 571 patients was used to identify the highest D-dimer cut-off point with a negative predictive value of at least 98% for the subgroup of patients with low and high pretest probability. The D-dimer cut-off point for those with moderate clinical pretest probability remained unchanged [0.5 fibrinogen equivalent units (FEU) microgram mL(-1)]. Accuracy of D-dimer testing for venous thromboembolism using three cut-off points vs. one cut-off point was than determined. D-dimer cut-off points of 0.2 and 2.1 FEU microgram mL(-1) were selected for the high and low pretest probability groups, respectively. When three pretest probability-specific cut-off points were used instead of the previously determined single D-dimer cut-off point (0.5 FEU microgram mL(-1)), sensitivity and negative predictive value were unchanged (95 and 98%, respectively), but specificity increased from 44.7 to 60.4% (P < 0.001). This resulted in exclusion of venous thromboembolism in 80 additional patients. Use of three pretest probability-specific D-dimer cut-off points rather than a single D-dimer cut-off point for all patients, has the potential to increase the utility of D-dimer testing for the diagnosis of venous thromboembolism.

Authors+Show Affiliations

Department of Medicine, Henderson Research Center, McMaster University, Hamilton, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

15304026

Citation

Linkins, L A., et al. "Use of Different D-dimer Levels to Exclude Venous Thromboembolism Depending On Clinical Pretest Probability." Journal of Thrombosis and Haemostasis : JTH, vol. 2, no. 8, 2004, pp. 1256-60.
Linkins LA, Bates SM, Ginsberg JS, et al. Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability. J Thromb Haemost. 2004;2(8):1256-60.
Linkins, L. A., Bates, S. M., Ginsberg, J. S., & Kearon, C. (2004). Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability. Journal of Thrombosis and Haemostasis : JTH, 2(8), 1256-60.
Linkins LA, et al. Use of Different D-dimer Levels to Exclude Venous Thromboembolism Depending On Clinical Pretest Probability. J Thromb Haemost. 2004;2(8):1256-60. PubMed PMID: 15304026.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability. AU - Linkins,L A, AU - Bates,S M, AU - Ginsberg,J S, AU - Kearon,C, PY - 2004/8/12/pubmed PY - 2005/3/8/medline PY - 2004/8/12/entrez SP - 1256 EP - 60 JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. VL - 2 IS - 8 N2 - Currently, the same D-dimer cut-off point is used to define a positive result for all patients with suspected venous thromboembolism, regardless of their pretest probability. However, use of a relatively high D-dimer cut-off point (lower sensitivity) for those with a low clinical pretest probability, and a low D-dimer cut-off point (higher sensitivity) for those with a high clinical pretest probability, may be preferable. To determine if using three different D-dimer cut-off points according to low, moderate or high clinical pretest probability has greater utility for exclusion of venous thromboembolism than using the same single D-dimer cut-off point in all patients. Data from a previously published study of 571 patients was used to identify the highest D-dimer cut-off point with a negative predictive value of at least 98% for the subgroup of patients with low and high pretest probability. The D-dimer cut-off point for those with moderate clinical pretest probability remained unchanged [0.5 fibrinogen equivalent units (FEU) microgram mL(-1)]. Accuracy of D-dimer testing for venous thromboembolism using three cut-off points vs. one cut-off point was than determined. D-dimer cut-off points of 0.2 and 2.1 FEU microgram mL(-1) were selected for the high and low pretest probability groups, respectively. When three pretest probability-specific cut-off points were used instead of the previously determined single D-dimer cut-off point (0.5 FEU microgram mL(-1)), sensitivity and negative predictive value were unchanged (95 and 98%, respectively), but specificity increased from 44.7 to 60.4% (P < 0.001). This resulted in exclusion of venous thromboembolism in 80 additional patients. Use of three pretest probability-specific D-dimer cut-off points rather than a single D-dimer cut-off point for all patients, has the potential to increase the utility of D-dimer testing for the diagnosis of venous thromboembolism. SN - 1538-7933 UR - https://www.unboundmedicine.com/medline/citation/15304026/Use_of_different_D_dimer_levels_to_exclude_venous_thromboembolism_depending_on_clinical_pretest_probability_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1538-7933&amp;date=2004&amp;volume=2&amp;issue=8&amp;spage=1256 DB - PRIME DP - Unbound Medicine ER -