D-dimer testing: advantages and limitations in emergency medicine for managing acute venous thromboembolism

SummaryThe natural history of initially positive D-dimers for venous thromboembolism is not known. If it returns to negative in the majority of patients, it would be potentially helpful to diagnose a recurrence. In this study, we prospectively measured D-dimer levels in outpatients with a diagnosis of venous thrombo-embolism. There were a total of 152 patients with an average age of 57. D-dimer results were performed at baseline and repeated at one week, one month and three months.At baseline 120 of 152 (79%) had a positive D-dimer result. Of those with an initially positive result, 80% were still positive at one week and 39% were still positive at one month. Finally at three months, 13% remained positive. Seven patients had recurrent events and all had persistently elevated D-dimers at one month. This study suggests that a persistently positive D-dimer result after one month of treatment may indicate a higher risk of recurrent venous thromboembolism. D-dimer testing for the diagnosis of recurrence of venous thromboembolism deserves further study.

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D-dimer testing and acute venous thromboembolism. A shortcut to accurate diagnosis?

Archives of Internal Medicine ◽

10.1001/archinte.156.9.939 ◽

1996 ◽

Vol 156 (9) ◽

pp. 939-946 ◽

Cited By ~ 34

Author(s):

D. M. Becker

Keyword(s):

Venous Thromboembolism ◽

Accurate Diagnosis ◽

Acute Venous Thromboembolism ◽

D Dimer

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Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

TH Open ◽

10.1055/s-0040-1714210 ◽

2020 ◽

Vol 04 (03) ◽

pp. e178-e188

Author(s):

Maria Farm ◽

Aleksandra Antovic ◽

David E. Schmidt ◽

Niklas Bark ◽

Nida Soutari ◽

...

Keyword(s):

Venous Thromboembolism ◽

Venous Thrombosis ◽

Thrombin Generation ◽

Medical Emergency ◽

Diagnostic Study ◽

Healthy Controls ◽

Clinical Biomarkers ◽

Acute Venous Thromboembolism ◽

Fibrin Monomers ◽

D Dimer

Abstract Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE. Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE. Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records. Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay. Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.

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