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D-Dimer Assays Not Enough For Diagnosis of Likely Deep Vein Thrombosis

A high pretest probability of deep vein thrombosis calls for a differential strategy that distinguishes between cases of low and high clinical probability using either a D-dimer test or ultrasonography.

This is the conclusion of Danish researchers following an assessment of the diagnostic reliability of a new quantitative D-dimer assay and an established quick test versus ultrasonography in the diagnosis of deep vein thrombosis (DVT).

A third assay became available during sample collection and is included in the final assessment.

One hundred and thirteen hospital outpatients with suspected DVT participated in this prospective study by T B Larsen. MD, PhD, and colleagues from the Aalborg Hospital, Aalborg.

Compression ultrasonography was used as the reference method for a diagnosis of DVT and compared with the different D-dimer assays. Results were expressed as sensitivity, specificity, positive predictive value and negative predictive value (NPV).

Deep vein thrombosis was established in 49 patients (43 percent) of the 113 patients.

The two D-dimer assays showed, respectively, sensitivities of 90 percent and 88 percent, specificities of 42 percent and 44 percent and NPVs of 85 percent and 83 percent.

While the diagnostic performance of the two D-dimer assays is almost identical, these authors suggest neither is suitable as the only screening method for DVT in a situation with a high pretest probability of DVT.
J Intern Med 2002; 252: 36-40. "Validity of D-dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays"

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