Clinical evaluation of a diagnostic strategy for deep venous thrombosis with exclusion by low plasma levels of fibrin degradation product D-dimer

1998 ◽  
Vol 58 (4) ◽  
pp. 307-316 ◽  
Author(s):  
T L Lindahl ◽  
T H Lundahl ◽  
M Ranby ◽  
S-G Fransson
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clinical Evaluation ◽  
Degradation Product ◽  
Plasma Levels ◽  
Diagnostic Strategy ◽  
Fibrin Degradation Product ◽  
D Dimer

scholarly journals Reliability of Five Rapid D-Dimer Assays Compared to ELISA in the Exclusion of Deep Venous Thrombosis

1997 ◽  
Vol 77 (02) ◽  
pp. 262-266 ◽  
Author(s):  
M C H Janssen ◽  
A E Heebels ◽  
M de Metz ◽  
H Verbruggen ◽  
H Wollersheim ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Negative Predictive Value ◽  
Degradation Product ◽  
Predictive Value ◽  
Clinical Management ◽  
Screening Test ◽  
Latex Agglutination ◽  
Fibrin Degradation Product ◽  
D Dimer

SummaryStudies measuring the fibrin degradation product D-Dimer (DD) using enzyme-linked immunosorbent assays (ELISA) in patients with venographically proven deep venous thrombosis (DVT) suggest that it is possible to exclude DVT when DD level is below a certain cut-off level. However, ELISA methods are time-consuming and not available in all laboratories. Different rapid latex-agglutination assays have been investigated, but their sensitivity is considerably lower.In the present study we compared the value of four novel latex DD tests (Tinaquant®, Minutex®, Ortho® and SimpliRed®) and one rapid ELISA (VIDAS®) to a classical ELISA DD assay (Organon Mab Y18®) in 132 patients suspected of DVT.The VIDAS®, a new quantitative automated ELISA, had a sensitivity of 100% and a negative predictive value of 100% for both proximal and distal DVT at a cut-off level of 500 ng/ml. The Tinaquant® assay, a new quantitative latex method, had a sensitivity of 99% and a negative predictive value of 93% for both proximal and distal DVT at a cut-off level of 500 ng/ml. For proximal DVT only, both assays had a sensitivity and negative predictive value of 100%. VIDAS® and Tinaquant® correlated well with ELISA (correlation of r = 0.96 and r = 0.98 respectively). Sensitivities of the semi-quantitative latex assays Minutex®, Ortho® and SimpliRed® were considerably lower (77%, 51 % and 61 % respectively).These results suggest that VIDAS® and Tinaquant® may be used instead of ELISA DD in the exclusion of DVT. Tinaquant® can be performed within 20 min and VIDAS® within 35 min. Both assays might be used as a routine screening test and should be evaluated in large clinical management studies.

Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis

1993 ◽  
Vol 69 (01) ◽  
pp. 008-011 ◽  
Author(s):  
Cedric J Carter ◽  
D Lynn Doyle ◽  
Nigel Dawson ◽  
Shauna Fowler ◽  
Dana V Devine
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Clinical Utility ◽  
Rapid Test ◽  
Fibrin Degradation Product ◽  
Current Form ◽  
Non Invasive ◽  
Clinically Significant ◽  
D Dimer

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

Clinical evaluation of eight different D-dimer tests for the exclusion of deep venous thrombosis in primary care patients

2015 ◽  
Vol 75 (3) ◽  
pp. 230-238 ◽  
Author(s):  
Rob F. M. Oude Elferink ◽  
Annemarieke E. Loot ◽  
Chantal G. J. Van De Klashorst ◽  
Marieke Hulsebos-Huygen ◽  
Margriet Piersma-Wichers ◽  
...  
Keyword(s):  
Primary Care ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clinical Evaluation ◽  
Primary Care Patients ◽  
D Dimer

A Diagnostic Strategy Involving a Quantitative Latex d-Dimer Assay Reliably Excludes Deep Venous Thrombosis

2003 ◽  
Vol 138 (10) ◽  
pp. 787 ◽  
Author(s):  
Shannon M. Bates ◽  
Clive Kearon ◽  
Mark Crowther ◽  
Lori Linkins ◽  
Martin O'Donnell ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Diagnostic Strategy ◽  
D Dimer

scholarly journals Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hong Xu ◽  
Jinwei Xie ◽  
Duan Wang ◽  
Qiang Huang ◽  
Zeyu Huang ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Interleukin 6 ◽  
Degradation Product ◽  
Plasma Levels ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
High Sensitivity ◽  
Youden Index ◽  
Fibrin Degradation Product ◽  
D Dimer

Abstract Background The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis. Methods We retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index. Results Based on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%. Conclusions Plasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.

scholarly journals Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Maryam Rahiminejad ◽  
Anshul Rastogi ◽  
Shirish Prabhudesai ◽  
David Mcclinton ◽  
Peter MacCallum ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Clinical Risk Factor ◽  
Diagnostic Pathway ◽  
Clinical Diagnostic ◽  
Retrospective Audit ◽  
Wells Score ◽  
D Dimer

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

scholarly journals The use of a fixed high sensitivity to evaluate five D-dimer assays' ability to rule out deep venous thrombosis: a novel approach

2005 ◽  
Vol 131 (3) ◽  
pp. 341-347 ◽  
Author(s):  
Scott M. Stevens ◽  
C. Gregory Elliott ◽  
Scott C. Woller ◽  
Liang Li ◽  
Sterling T. Bennett ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
High Sensitivity ◽  
Novel Approach ◽  
D Dimer ◽  
Rule Out
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