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Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism.
Arch Intern Med. 2006 Jan 23; 166(2):176-80.AI

Abstract

BACKGROUND

D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence.

METHODS

We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up.

RESULTS

The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery.

CONCLUSIONS

In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.

Authors+Show Affiliations

Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France. gregoire.legal@chu-brest.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16432085

Citation

Le Gal, Grégoire, et al. "Value of D-dimer Testing for the Exclusion of Pulmonary Embolism in Patients With Previous Venous Thromboembolism." Archives of Internal Medicine, vol. 166, no. 2, 2006, pp. 176-80.
Le Gal G, Righini M, Roy PM, et al. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med. 2006;166(2):176-80.
Le Gal, G., Righini, M., Roy, P. M., Sanchez, O., Aujesky, D., Perrier, A., & Bounameaux, H. (2006). Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Archives of Internal Medicine, 166(2), 176-80.
Le Gal G, et al. Value of D-dimer Testing for the Exclusion of Pulmonary Embolism in Patients With Previous Venous Thromboembolism. Arch Intern Med. 2006 Jan 23;166(2):176-80. PubMed PMID: 16432085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. AU - Le Gal,Grégoire, AU - Righini,Marc, AU - Roy,Pierre-Marie, AU - Sanchez,Oliver, AU - Aujesky,Drahomir, AU - Perrier,Arnaud, AU - Bounameaux,Henri, PY - 2006/1/25/pubmed PY - 2006/2/24/medline PY - 2006/1/25/entrez SP - 176 EP - 80 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 166 IS - 2 N2 - BACKGROUND: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. METHODS: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery. CONCLUSIONS: In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16432085/Value_of_D_dimer_testing_for_the_exclusion_of_pulmonary_embolism_in_patients_with_previous_venous_thromboembolism_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.166.2.176 DB - PRIME DP - Unbound Medicine ER -