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

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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Diagnostic Value of Plasma Thrombin-Antithrombin III Complex and D-Dimer Concentration in Patients with Varicose Veins for Exclusion of Deep-Vein Thrombosis

Thrombosis Research ◽

10.1016/s0049-3848(98)00081-4 ◽

1998 ◽

Vol 91 (2) ◽

pp. 101-104 ◽

Cited By ~ 6

Author(s):

Tomio Kawasaki ◽

Nobutoshi Shinoki ◽

Shin-ichi Iwamoto ◽

Hironobu Fujimura ◽

Norihide Yoshikawa ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Antithrombin Iii ◽

Varicose Veins ◽

Diagnostic Value ◽

Vein Thrombosis ◽

Deep Vein ◽

Thrombin Antithrombin Iii Complex ◽

D Dimer

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Predictive Value of Decreasing Antithrombin III in Deep-Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650103 ◽

1980 ◽

Vol 44 (03) ◽

pp. 135-137 ◽

Cited By ~ 2

Author(s):

Thorkild Lund Andreasen

Keyword(s):

Deep Vein Thrombosis ◽

Predictive Value ◽

Coronary Care Unit ◽

Antithrombin Iii ◽

Predictive Values ◽

Vein Thrombosis ◽

At Iii ◽

Coronary Care ◽

Time Of Admission ◽

Deep Vein

SummaryAntithrombin III (At-III) was measured at the time of admission and two days later in 131 patients laid up in a coronary care unit. The patients were examined for deep-vein thrombosis (DVT) clinically and by means of 125I-fibrinogen scanning. 19 patients developed DVT. In 11 subjects with and 25 without DVT At-III decreased more than 10%. And in 7 with and 17 without DVT At-III decreased more than 15%. One person with DVT had subnormal At-III. By using decrease of At-III or subnormal initial At-III to predict DVT the following predictive value (PV) were found. Decrease ≤ 10%, PV pos.= 0.32 and PV neg. = 0.93. Decrease ≤ 15%, PV pos. = 0.32 and PV neg. = 0.90. The positive predictive values obtained were too low to let decreasing At-III give occasion for prophylactic anticoagulant treatment.

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Diagnostic Accuracy of a New d-Dimer Assay (Sclavo Auto d-Dimer) for Exclusion of Deep Vein Thrombosis in Symptomatic Outpatients

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029616649436 ◽

2016 ◽

Vol 23 (3) ◽

pp. 221-228 ◽

Cited By ~ 1

Author(s):

Cristina Legnani ◽

Michela Cini ◽

Mirella Frascaro ◽

Giuseppina Rodorigo ◽

Michelangelo Sartori ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Imaging Techniques ◽

False Negative ◽

High Specificity ◽

Predictive Values ◽

Cutoff Value ◽

Vein Thrombosis ◽

Number Of Patients ◽

Deep Vein ◽

D Dimer

In patients presenting non-high clinical pretest probability (PTP), a negative d-dimer can exclude venous thromboembolism without imaging tests. However, each d-dimer assay should be validated in prospective studies. We evaluated an automated d-dimer immunoassay using the Sclavo Auto d-dimer (Sclavo Diagnostics Int, Sovicille, Italy) provided by Dasit Diagnostica (Cornaredo, Milan, Italy). Three hundred two consecutive outpatients suspected of leg deep vein thrombosis (DVT) with non-high PTP were included. The Sclavo Auto d-dimer assay was evaluated on 2 analyzers (Sysmex CA-7000 and Sysmex CS-2100; Sysmex Corporation, Kobe, Japan, provided by Dasit). The cutoff value (200 ng/mL) was established a priori. Prevalence of DVT was 11.9%. Since no false-negative patients were detected, the sensitivity and negative predictive values (NPVs) were 100% (sensitivity = CA-7000: 100% [95% confidence interval, CI: 93.3-100], CS-2100: 100% [95% CI: 93.3-100]; NPV = CA-7000: 100% [95% CI: 97.9-100], CS-2100: 100% [95% CI: 98.0-100]). Specificity was 65.4% (95% CI: 59.4-71.1) and 69.2% (95% CI: 63.3-74.7) for CA-7000 and CS-2100, respectively. Specificity increased when a higher cutoff value (234 ng/mL) was used for patients aged ≥60 years without compromising the safety. Assay reproducibility was satisfactory at concentrations near the cutoff value (total coefficient of variations <10%). In conclusion, the Sclavo Auto d-dimer assay was accurate when used for DVT diagnostic workup in outpatients with non-high PTP. Based on its high sensitivity and NPV, it can be used as a stand-alone test in outpatients with non-high PTP. Given its high specificity, the number of patients in whom further imaging techniques can be avoided increased, improving the yield of the test.

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Performance of five D-dimer assays for the exclusion of symptomatic distal leg vein thrombosis

Thrombosis and Haemostasis ◽

10.1160/th11-07-0511 ◽

2012 ◽

Vol 107 (02) ◽

pp. 369-378 ◽

Cited By ~ 14

Author(s):

Jan Schwonberg ◽

Carola Hecking ◽

Marc Schindewolf ◽

Dimitrios Zgouras ◽

Susanne Lehmeyer ◽

...

Keyword(s):

High Sensitivity ◽

Diagnostic Value ◽

Vein Thrombosis ◽

Clinical Probability ◽

Wells Score ◽

Deep Vein ◽

Test Result ◽

D Dimer ◽

Rule Out ◽

Compression Ultrasonography

SummaryThe diagnostic value of D-dimer (DD) in the exclusion of proximal deep-vein thrombosis (DVT) is well-established but is less well-known in the exclusion of distal (infrapopliteal) DVT. Therefore, we evaluated the diagnostic abilities of five DD assays (Vidas-DD, Liatest-DD, HemosIL-DD, HemosIL-DDHS, Innovance-DD) for excluding symptomatic proximal and distal leg DVT. A total of 243 outpatients whose symptoms were suggestive of DVT received complete compression ultrasonography (cCUS) of the symptomatic leg(s). The clinical probability of DVT (PTP) was assessed by Wells score. Thirty-eight proximal and 31 distal DVTs (17 tibial/fibular DVTs, 14 muscle DVTs) were diagnosed by cCUS. Although all assays showed high sensitivity for proximal DVT (range 97–100%), the sensitivity was poor for distal DVT (range 78–93%). None of the assays were individually able to rule out all DVTs as a stand-alone test (negative predictive value [NPV] 91–96%). However, a negative DD test result combined with a low PTP exhibited a NPV of 100% for all DVTs (including proximal, tibial/fibular, and muscle DVTs) with the HemosIL-DDHS and Innovance-DD. All proximal and tibial/fibular DVTs, but not all muscle DVTs, could be ruled out with this strategy using the Liatest-DD and Vidas-DD. The HemosIL-DD could not exclude distal leg DVT, even in combination with a low PTP. The combination of a negative DD with a low PTP showed a specificity of 32–35% for all DVTs. In conclusion, our study shows that when used in conjunction with a low PTP some DD assays are useful tools for the exclusion of distal leg DVT.

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Clinical Evaluation for the Role of High-Sensitivity C-Reactive Protein in Combination with D-Dimer and Wells Score Probability Test to Predict the Incidence of Deep Vein Thrombosis Among Cancer Patients

International Journal of General Medicine ◽

10.2147/ijgm.s261718 ◽

2020 ◽

Vol Volume 13 ◽

pp. 587-594

Author(s):

Budi Setiawan ◽

Rosalina Rosalina ◽

Eko Adhi Pangarsa ◽

Damai Santosa ◽

Catharina Suharti

Keyword(s):

Deep Vein Thrombosis ◽

Cancer Patients ◽

High Sensitivity ◽

C Reactive Protein ◽

Vein Thrombosis ◽

Reactive Protein ◽

Wells Score ◽

Deep Vein ◽

D Dimer

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Sensitivity and specificity of D-dimer tests comparing to the ultrasound examination of deep vein thrombosis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180222038m ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 303-308

Author(s):

Dragan Markovic ◽

Dragan Vasic ◽

Jelena Basic ◽

Slobodan Tanaskovic ◽

Slobodan Cvetkovic ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Sensitivity And Specificity ◽

Predictive Values ◽

Vein Thrombosis ◽

Wells Score ◽

Examination Methods ◽

False Diagnosis ◽

Deep Vein ◽

D Dimer ◽

Compression Ultrasonography

Introduction/Objective. Untreated deep vein thrombosis (DVT) is associated with a high risk of pulmonary embolism (PE), and false diagnosis of DVT results in unnecessary anticoagulant therapy, with a risk of bleeding. Accurate diagnosis of DVT and prompt therapy are essential to reduce the risk of thromboembolic complications. The aim of our study was to evaluate the sensitivity and specificity of three D-dimer tests (DD PLUS, HemosIL, and VIDAS) comparing to compression ultrasonography (CUS) examination. Methods. We observed 350 patients, some with different risk factors. The patients underwent the same protocol (evaluation of the patient?s history, physical examination, and D-dimer testing), and CUS was used as a reference for all the patients. According to Wells score, the patients were divided into groups with low, moderate, and high pretest probability (PTP). Results. Most of the examined patients were with moderate PTP. The CUS showed that there was the highest number of examined patients without DVT. Most of the examined patients with a positive CUS finding had proximal iliac and femoral DVT. VIDAS test was positive in the highest percentage in the group of patients with CUS-documented thrombosis. Conclusion. All three D-dimer tests used in our study had similar sensitivity and specificity. However, VIDAS test had higher levels of positive and negative predictive values comparing to the others. The comparison of three D-dimer tests by an ROC curve showed that VIDAS test has the highest overall statistical accuracy of all three D-dimer tests.

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Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema

Journal of Blood Medicine ◽

10.2147/jbm.s291226 ◽

2021 ◽

Vol Volume 12 ◽

pp. 313-325

Author(s):

Ikhwan Rinaldi ◽

Rachmat Hamonangan ◽

Mohamad Syahrir Azizi ◽

Rahmat Cahyanur ◽

Fadila Wirawan ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Biological Markers ◽

Diagnostic Value ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Vein Thrombosis ◽

Limb Edema ◽

Deep Vein ◽

D Dimer

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A Negative D-dimer Excludes Recurrent Deep Vein Thrombosis: Results of a Multicentre Management Study.

Blood ◽

10.1182/blood.v110.11.698.698 ◽

2007 ◽

Vol 110 (11) ◽

pp. 698-698 ◽

Cited By ~ 9

Author(s):

Shannon Bates ◽

Clive Kearon ◽

Susan Kahn ◽

Jim A. Julian ◽

Mark A. Crowther ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

High Sensitivity ◽

Vein Thrombosis ◽

Recurrent Deep Vein Thrombosis ◽

Clinically Significant ◽

Suspected Recurrence ◽

Lost To Follow Up ◽

Deep Vein ◽

D Dimer

Abstract The high frequency of residual radiologic abnormalities after initial deep vein thrombosis (DVT) makes management of patients with suspected recurrence difficult. D-dimer (DD) and serial compression ultrasonography (CUS) of the proximal veins have a high sensitivity and negative predictive value (NPV) in suspected first DVT. We hypothesized that it would be safe to withhold anticoagulation in patients with suspected recurrence who had a negative sensitive DD or negative serial CUS when DD testing was positive. In a multicentre prospective cohort study, patients underwent DD testing with an immunoturbidometric assay (MDA DD). If the DD was negative (<0.5 ug fibrinogen equivalent units [FEU]/mL), patients had no further testing. If the DD was positive, CUS was performed and, if normal, repeated after 1–3 and 7–10 days. Patients with a positive DD and abnormal CUS at presentation were managed as per their treating physician. Patients were followed for 3 months to detect venous thromboembolism (VTE) and suspected VTE were adjudicated centrally. Of the 504 patients enrolled in this study, 14 were subsequently deemed ineligible and 2 patients were lost to follow-up. The overall prevalence of confirmed recurrent DVT at presentation or during follow-up was 17%. 230 patients had a negative DD at presentation and, of the 227 evaluable patients, 4 had definite confirmed VTE (NPV of DD = 98%; 95% Confidence Interval [CI], 96–99%). Of the 135 patients with a positive DD and normal initial CUS, serial CUS was negative in 129 cases. Of these patients, 3 had definite VTE during follow-up (NPV of serial CUS in patients with positive DD = 98%; 95% CI, 93–99%). These results suggest that a negative MDA DD result excludes clinically significant recurrent DVT and that anticoagulants can also be safely withheld in patients with negative serial CUS, even if their DD is positive. This simple diagnostic approach can be used to safely manage approximately 70% of patients with suspected recurrent DVT.

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