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Outpatient D-dimer Test Can Exclude Deep Venous Thrombosis
A DGReview of :"Usefulness of a semiquantitative D-dimer test for the exclusion of deep venous thrombosis in outpatients"
American Journal of Medicine
06/28/2002
By Anne MacLennan
A semiquantitative D-dimer test has been found to have high sensitivity and negative predictive value in exclusion of deep venous thrombosis.
The finding has some exceptions, however, suggests this study from The Netherlands.
Test sensitivity is lower in people using oral anticoagulants. Also, D-dimer tests are usually positive and thus may not be worthwhile in people with cancer and in patients more than 70 years of age.
The D-dimer test is used commonly in diagnostic strategies to reduce the need for ultrasonography in patients suspected of having deep venous thrombosis.
In this retrospective cohort study, Roger E.G. Schutgens and colleagues from St. Antonius Hospital, Nieuwegein, and University Hospital, Utrecht, examined several clinical and laboratory variables that might limit the accuracy of a semiquantitative D-dimer test.
Participants were 704 outpatients suspected of having deep venous thrombosis, all of whom underwent the semiquantitative D-dimer test and ultrasonography.
Researchers calculated the performance of the test in 61 patients using anticoagulants, 117 patients with previous thrombosis and 47 patients with malignancy, including 39 patients with more than one of these characteristics. The remaining patients were considered to be the reference group.
Two hundred and fifty four patients (36 percent) showed evidence of deep venous thrombosis.
In the reference group, the D-dimer test had a sensitivity of 99 percent and a negative predictive value of 98 percent. In patients on oral anticoagulants, however, test sensitivity was only 75 percent.
Although sensitivity was 96 percent in patients with previous thrombosis and 100 percent in patients with cancer, 97 percent (553) of all patients, including 43 of the cancer patients (91 percent), had an abnormal D-dimer test.
American Journal of Medicine Volume 112, Issue 8 Pages 617-621
"Usefulness of a semiquantitative D-dimer test for the exclusion of deep venous thrombosis in outpatients"
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