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Diagnosis of deep vein thrombosis: how many tests do we need?
Acta Chir Belg. 2005 Feb; 105(1):16-25.AC

Abstract

The requirement for a safe diagnostic strategy should be based on an overall post-test incidence of venous thromboembolism (VTE) of less than 1% during 3 month follow-up. Compression ultrasonography (CUS) has a negative predictive value (NPV) of 97 to 98% indicating a post-CUS incidence of deep vein thrombosis (DVT) of 2 to 3%. A post-CUS DVT incidence of 3% implicates that 90 to 120 DVTs per 1 million inhabitants will be overlooked each year indicating the need to improve the diagnostic work-up of DVT as much as possible. The qualitative D-dimer test (SimpliRed) has a sensitivity of 82 to 89% and a negative predictive value of 94 to 95% indicating a 5 to 6% post-test incidence of DVT, which is not sensitive enough for venous thrombosis exclusion. The post-test DVT incidence could be reduced from 3.2% to 0.6% in one study and from 11% to 2% in another study by the combination of a normal CUS and low clinical score and from 4.5% to 1.6% by the combination of low clinical score and a negative SimpliRed test in one study. The combination of a negative CUS and a negative SimpliRed test reduced the post-test incidence of DVT from 2.6% to < 1% or even < 1% in two management studies without the need of a repeated CUS on the basis of which anticoagulant therapy can safely be withheld. The rapid quantitative turbidimetric D-dimer assay (Tinaquant) has a sensitivity and a negative predictive value (NPV) of 97.7% with a 2.3% post-test incidence of DVT. The combination of a normal Tinaquant D-Dimer test result plus a low to moderate clinical score reduces the post-test incidence of DVT from 2.3 to 0.6% without the need of CUS testing in 29% of patients with suspected DVT. The rapid ELISA VIDAS D-dimer assay has a sensitivity and NPV of 98.6 and 99.5% in two management studies for the exclusion of DVT irrespective of clinical score. The combination of a normal ELISA VIDAS D-Dimer test with clinical score assessment will reduce the post-test DVT incidence of less than 0.5% and the need for CUS testing by 40 to 50%. It is concluded that the sequential use of a rapid quantitative D-dimer test, clinical score and CUS appears to be safe and the most cost-effective diagnostic work-up of DVT.

Authors+Show Affiliations

Hemostasis and Thrombosis Research, Department of Hematology, University Hospital Antwerp, Edegem. jan.michiels@uza.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15790198

Citation

Michiels, J J., et al. "Diagnosis of Deep Vein Thrombosis: How Many Tests Do We Need?" Acta Chirurgica Belgica, vol. 105, no. 1, 2005, pp. 16-25.
Michiels JJ, Gadisseur A, van der Planken M, et al. Diagnosis of deep vein thrombosis: how many tests do we need? Acta Chir Belg. 2005;105(1):16-25.
Michiels, J. J., Gadisseur, A., van der Planken, M., Schroyens, W., Berneman, Z., De Maeseneer, M., Hermsen, J. T., & Trienekens, P. H. (2005). Diagnosis of deep vein thrombosis: how many tests do we need? Acta Chirurgica Belgica, 105(1), 16-25.
Michiels JJ, et al. Diagnosis of Deep Vein Thrombosis: How Many Tests Do We Need. Acta Chir Belg. 2005;105(1):16-25. PubMed PMID: 15790198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of deep vein thrombosis: how many tests do we need? AU - Michiels,J J, AU - Gadisseur,A, AU - van der Planken,M, AU - Schroyens,W, AU - Berneman,Z, AU - De Maeseneer,M, AU - Hermsen,J T, AU - Trienekens,P H, PY - 2005/3/26/pubmed PY - 2005/6/29/medline PY - 2005/3/26/entrez SP - 16 EP - 25 JF - Acta chirurgica Belgica JO - Acta Chir Belg VL - 105 IS - 1 N2 - The requirement for a safe diagnostic strategy should be based on an overall post-test incidence of venous thromboembolism (VTE) of less than 1% during 3 month follow-up. Compression ultrasonography (CUS) has a negative predictive value (NPV) of 97 to 98% indicating a post-CUS incidence of deep vein thrombosis (DVT) of 2 to 3%. A post-CUS DVT incidence of 3% implicates that 90 to 120 DVTs per 1 million inhabitants will be overlooked each year indicating the need to improve the diagnostic work-up of DVT as much as possible. The qualitative D-dimer test (SimpliRed) has a sensitivity of 82 to 89% and a negative predictive value of 94 to 95% indicating a 5 to 6% post-test incidence of DVT, which is not sensitive enough for venous thrombosis exclusion. The post-test DVT incidence could be reduced from 3.2% to 0.6% in one study and from 11% to 2% in another study by the combination of a normal CUS and low clinical score and from 4.5% to 1.6% by the combination of low clinical score and a negative SimpliRed test in one study. The combination of a negative CUS and a negative SimpliRed test reduced the post-test incidence of DVT from 2.6% to < 1% or even < 1% in two management studies without the need of a repeated CUS on the basis of which anticoagulant therapy can safely be withheld. The rapid quantitative turbidimetric D-dimer assay (Tinaquant) has a sensitivity and a negative predictive value (NPV) of 97.7% with a 2.3% post-test incidence of DVT. The combination of a normal Tinaquant D-Dimer test result plus a low to moderate clinical score reduces the post-test incidence of DVT from 2.3 to 0.6% without the need of CUS testing in 29% of patients with suspected DVT. The rapid ELISA VIDAS D-dimer assay has a sensitivity and NPV of 98.6 and 99.5% in two management studies for the exclusion of DVT irrespective of clinical score. The combination of a normal ELISA VIDAS D-Dimer test with clinical score assessment will reduce the post-test DVT incidence of less than 0.5% and the need for CUS testing by 40 to 50%. It is concluded that the sequential use of a rapid quantitative D-dimer test, clinical score and CUS appears to be safe and the most cost-effective diagnostic work-up of DVT. SN - 0001-5458 UR - https://www.unboundmedicine.com/medline/citation/15790198/Diagnosis_of_deep_vein_thrombosis:_how_many_tests_do_we_need L2 - http://www.diseaseinfosearch.org/result/7087 DB - PRIME DP - Unbound Medicine ER -