D-Dimer Tests Not Predictive of VTE in Elderly

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

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Comparison of D-Dimer Activity and Residual Particle Size Produced Following Thrombus Disruption by Perfluorocarbon Containing Microbubbles Versus Urokinase in the Presence of Low Frequency Ultrasound

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84657-8 ◽

1998 ◽

Vol 31 (2) ◽

pp. 219A ◽

Cited By ~ 2

Author(s):

T Porter

Keyword(s):

Particle Size ◽

Low Frequency ◽

Low Frequency Ultrasound ◽

D Dimer ◽

Frequency Ultrasound

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Role of a Quantitative d-Dimer Assay in Determining the Need for CT Angiography of Acute Pulmonary Embolism

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70294-x ◽

2006 ◽

Vol 2006 ◽

pp. 381-382

Author(s):

G.L. Moneta

Keyword(s):

Pulmonary Embolism ◽

Ct Angiography ◽

Acute Pulmonary Embolism ◽

D Dimer

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Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70277-x ◽

2006 ◽

Vol 2006 ◽

pp. 361-362

Author(s):

G.L. Moneta

Keyword(s):

Venous Thromboembolism ◽

Predictive Value ◽

Recurrent Venous Thromboembolism ◽

D Dimer

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Automated Latex Agglutination and ELISA Testing Yield Equivalent D-Dimer Results in Patients with Recent Myocardial Infarction

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614846 ◽

1999 ◽

Vol 82 (11) ◽

pp. 1412-1416 ◽

Cited By ~ 5

Author(s):

Wojciech Zareba ◽

John Horan ◽

Arthur Moss ◽

Joel Kanouse ◽

◽

...

Keyword(s):

Myocardial Infarction ◽

Elisa Test ◽

Mean Value ◽

Latex Agglutination ◽

Test Results ◽

Coronary Death ◽

Elisa Testing ◽

Strong Linear Correlation ◽

Highly Correlated ◽

D Dimer

SummaryOur previous prospective study of post-infarction patients described a strong and significant association of increased plasma D-dimer concentrations in those who experienced a subsequent coronary death or non-fatal myocardial infarction. In the present study, we compare results on stored plasma obtained two months after the index myocardial infarction from 1,038 patients of this trial, using a simple automated latex agglutination (LA) assay in parallel with the standard ELISA test. Results show a somewhat higher mean value for the LA assay (702 ± 1092 vs. 638 ± 986 ng/ml, p = 0.0002), a strong linear correlation of the two assays (r = 0.86) and 88% agreement for values below 500 ng/ml by the ELISA test. D-dimer concentrations determined by each assay were highly correlated in patients with subsequent coronary artery events (p = 0.93) and quartile values for both the LA and ELISA were equally predictive of such events (p = 0.003 and p = 0.001, respectively). This is the first demonstration that a latex agglutination assay for D-dimer can be used to assess the prognostic risk of recurrent coronary thrombotic disease after myocardial infarction

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APC Resistance and other Haemostatic Variables during Pregnancy and Puerperium

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614518 ◽

1999 ◽

Vol 81 (04) ◽

pp. 527-531 ◽

Cited By ~ 114

Author(s):

U. Kjellberg ◽

N.-E. Andersson ◽

S. Rosén ◽

L. Tengborn ◽

M. Hellgren

Keyword(s):

Factor Viii ◽

Plasminogen Activator ◽

Protein C ◽

Activated Protein C ◽

Plasminogen Activator Inhibitor ◽

Protein S ◽

Reference Level ◽

Soluble Fibrin ◽

Prothrombin Fragment ◽

D Dimer

SummaryForty-eight healthy pregnant women were studied prospectively and longitudinally. Blood sampling was performed at 10-15, 23-25, 32-34 and 38-40 weeks of gestation, within one week and at eight weeks postpartum. Classic and modified activated protein C ratio decreased as pregnancy progressed. In the third trimester 92% of the ratios measured with the classic test were above the lower reference level whereas all modified test ratios were normal. Slight activation of blood coagulation was shown with increased levels of prothrombin fragment 1+2, soluble fibrin and D-dimer. Fibrinogen, factor VIII and plasminogen activator inhibitor type 1 and type 2 increased. Protein S and tissue plasminogen activator activity decreased. Protein C remained unchanged. No correlation was found between the decrease in classic APC ratio and changes in factor VIII, fibrinogen, protein S, prothrombin fragment 1+2 or soluble fibrin, nor between the increase in soluble fibrin and changes in prothrombin fragment 1+2, fibrinogen and D-dimer.

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Disseminierte intravasale Koagulopathie bei einem Hund mit Angiostrongylus-vasorum-Infektion

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.1055/s-0038-1623728 ◽

2013 ◽

Vol 41 (06) ◽

pp. 401-407 ◽

Cited By ~ 2

Author(s):

B. D. Kruse ◽

K. Hartmann ◽

A. Groth ◽

B. Schulz ◽

A. Wehner

Keyword(s):

Klinische Untersuchung ◽

Angiostrongylus Vasorum ◽

Respiratorische Symptome ◽

D Dimer

ZusammenfassungEine 2 Jahre alte kastrierte Epagneul-Breton-Hündin wurde wegen Ekchymosen bei ungestörtem Allgemeinbefinden vorgestellt. Die klinische Untersuchung ergab zusätzliche Petechien sowie ein Hämatom. Auslandsaufenthalte inkludierten Italien und Dänemark. Labordiagnostisch fielen eine mittelgradige Thrombozytopenie, verlängerte Gerinnungszeiten (PT, aPTT, TT) und eine erhöhte D-Dimer-Konzentration. Die initiale Therapie umfasste Plasmatransfusionen, Infusion sowie Doxycyclinund Famotidingabe. Die Infektionserkrankungen Babesiose, Ehrlichiose, Leishmaniose, Dirofilariose und Anaplasmose konnten nicht bestätigt werden. Eine sonographische Untersuchung des Abdomens ergab unauffällige Befunde, das Thoraxröntgen zeigte ein bronchointerstitielles Lungenmuster. Eine Sammelkotprobe über 3 Tage für ein Larvenauswanderungsverfahren nach Baermann war positiv für Angiostrongylus vasorum. Die A.-vasorum-Infektion wurde mit Fenbendazol erfolgreich therapiert, worauf die Thrombozytopenie und die abnormen Gerinnungszeiten rückläufig waren. Auch in Gebieten mit niedriger Prävalenz sollte bei Hunden mit Gerinnungsstörungen an eine A.-vasorum-Infektion gedacht werden. Respiratorische Symptome können bei dieser Erkrankung komplett fehlen. Der Patient könnte sich sowohl im Ausland als auch in Deutschland infiziert haben.

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D-Dimers, Thrombin Antithrombin III Complexes and Prothrombin Fragments 1 + 2: Diagnostic value in Clinically Suspected Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647449 ◽

1991 ◽

Vol 65 (01) ◽

pp. 028-032 ◽

Cited By ~ 105

Author(s):

B Boneu ◽

G Bes ◽

H Pelzer ◽

P Sié ◽

H Boccalon

Keyword(s):

Deep Vein Thrombosis ◽

Antithrombin Iii ◽

High Sensitivity ◽

Diagnostic Value ◽

Predictive Values ◽

Vein Thrombosis ◽

High Negative Predictive Value ◽

Deep Vein ◽

D Dimer ◽

Mercury Strain Gauge

SummaryThis study was performed to determine the accuracy of D-Dimer fibrin derivatives, thrombin-antithrombin III (TAT) complexes and prothrombin fragments 1 + 2 (F 1 + 2) determinations for the diagnosis of deep vein thrombosis (DVT). One hundred and sixteen consecutive patients referred to the angiology unit of our hospital for a clinically suspected DVT were investigated. They were submitted to mercury strain gauge plethysmography and to ultrasonic duplex scanning examination; in cases of inconclusive results or of proximal DVT (n = 35), an ascending phlebography was performed. After these investigations were completed, the diagnosis of DVT was confirmed in 34 and excluded in 82. One half of the patients were already under anticoagulant therapy at the time of investigation. The 3 biological markers were assayed using commercially available ELISA techniques and the D-Dimer was also assayed with a fast latex method. The normal distribution of these markers was established in 40 healthy blood donors. The most accurate assay for the diagnosis of DVT was the D-Dimer ELISA which had both a high sensitivity (94%) and a high negative predictive value (95%). The D-Dirner latex, TAT complexes and F 1 + 2 were far less sensitive and provided negative predictive values which ranged between 78 and 85%. In spite of positive and significant correlations between the levels of ihe 3 markers, their association did not improve their overall accuracy for detecting D\/L Therefore, with the exception of the D-Dimer ELISA, these markers were of little value for the diagnosis of DVT in this specific population.

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