Excluding venous thromboembolism using point of care D-dimer tests in out-patients: a diagnostic meta-analysis

»Point-of-Care« D-Dimer TestingD-dimer testing is efficient in the exclusion of venous thromboembolism (VTE). D-dimer laboratory assays are predominantly performed in centralised laboratories in intra-hospital settings although most patients with suspected VTE are presented in primary care. On the other hand decreasing turnaround time for laboratory testing may significantly improve efficacy in emergency departments. Therefore an introduction of a rapid, easy to perform point of care (POC) assay for the identification of D-dimer may offer improvement in diagnostics flow of VTE both in primary care and emergency departments while it could also improve our diagnostic possibilities in some other severe clinical conditions (e.g. disseminated intra-vascular coagulation (DIC) and aortic aneurism (AA)) associated with increased D-dimer. Several POC D-dimer assays have been evaluated and majority of them have met the criteria for rapid and safe exclusion of VTE. In our hands three assays (Stratus, Pathfast and Cardiac) have the laboratory performance profile comparable with our routine D-dimer laboratory assay (Tinaqaunt).

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AP063 A service evaluation to investigate the use of clinical decision rules and appropriateness of D-dimer requests in suspected venous thromboembolism, with a view to implement a point of care test for D-dimers within the emergency department at Bradford Royal Infirmary

Resuscitation ◽

10.1016/s0300-9572(11)70096-x ◽

2011 ◽

Vol 82 ◽

pp. S24

Author(s):

Sarah Hodgson ◽

David Robinson

Keyword(s):

Emergency Department ◽

Venous Thromboembolism ◽

Point Of Care ◽

Decision Rules ◽

Clinical Decision ◽

Service Evaluation ◽

Royal Infirmary ◽

Clinical Decision Rules ◽

Point Of Care Test ◽

D Dimer

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Increased D-dimer predicts the risk of cancer-associated recurrent venous thromboembolism and venous thromboembolism: A systematic review and meta-analysis

Thrombosis Research ◽

10.1016/j.thromres.2020.09.031 ◽

2020 ◽

Vol 196 ◽

pp. 410-413

Author(s):

Meng Yang ◽

Jiaqian Qi ◽

Yaqiong Tang ◽

Depei Wu ◽

Yue Han

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Meta Analysis ◽

Recurrent Venous Thromboembolism ◽

Risk Of Cancer ◽

D Dimer

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Point-of-care D-dimer tests can contribute to patient management in outpatients with suspected venous thromboembolism, particularly those at low risk

Evidence-Based Medicine ◽

10.1136/ebm1004 ◽

2010 ◽

Vol 15 (1) ◽

pp. 28-28

Author(s):

M. Tan ◽

M. V. Huisman

Keyword(s):

Venous Thromboembolism ◽

Patient Management ◽

Point Of Care ◽

Low Risk ◽

D Dimer

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Elevated d-dimer levels predict recurrence in patients with idiopathic venous thromboembolism: a meta-analysis

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2009.03293.x ◽

2009 ◽

Vol 7 (4) ◽

pp. 611-618 ◽

Cited By ~ 55

Author(s):

E. BRUINSTROOP ◽

F. A. KLOK ◽

M. A. VAN DE REE ◽

F. L. OOSTERWIJK ◽

M. V. HUISMAN

Keyword(s):

Venous Thromboembolism ◽

Meta Analysis ◽

D Dimer

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Clinical Characteristics and Outcomes of Venous Thromboembolism in Patients Hospitalized for COVID-19: Systematic Review and Meta-Analysis

10.1101/2020.06.14.20130922 ◽

2020 ◽

Cited By ~ 1

Author(s):

Joshua Henrina ◽

Iwan Cahyo Santosa Putra ◽

Irvan Cahyadi ◽

Hoo Felicia Hadi Gunawan ◽

Alius Cahyadi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Venous Thromboembolism ◽

Clinical Characteristics ◽

Meta Analysis ◽

White Blood Cells ◽

Male Gender ◽

Older Age ◽

Icu Admission ◽

D Dimer

ABSTRACTObjectiveTo investigate the clinical characteristics and outcomes of Coronavirus Disease of 2019 (COVID-19) patients complicated with venous thromboembolism (VTE)MethodWe performed a comprehensive literature search of several databases to find studies that assessed VTE in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE sufferers.ResultsEight studies have been included with a total of 1237 pooled subjects. Venous thromboembolism was associated with higher mortality (RR 2.48 (1.35, 4.55), p=0.003; I2 5%, p=0.35) after we performed sensitivity analysis, ICU admission (RR 2.32 (1.53, 3.52), p<0.0001; I2 80%, p <0.0001), and mechanical ventilation need (RR 2.73 (1.56, 4.78), p=0.0004; I2 77%, p=0.001). Furthermore, it was also associated to male gender (RR 1.21 (1.08, 1.35), p=0.0007; I2 12%, p=0.34), higher white blood cells count (MD 1.24 (0.08, 2.41), 0.04; I2 0%; 0.26), D-dimer (MD 4.49 (2.74, 6.25), p<0.00001; I2 67%, p=0.009) and LDH levels (MD 70.93 (19.33, 122.54), p<0.007; I2 21%, p=0.28). In addition, after sensitivity analysis was conducted, VTE also associated with older age (MD 2.79 (0.06, 5.53), p=0.05; I2 25%, p=0.24) and higher CRP levels (MD 2.57 (0.88, 4.26); p=0.003; I2 0%, p=0.96).ConclusionVenous thromboembolism in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male gender, older age, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE in COVID-19 patients during hospitalization.

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Abstract 14827: Risk of Venous Thromboembolism in Hospitalized COVID-19 Patients Undergoing Thromboprophylaxis: Meta-analysis of Cohort Studies

Circulation ◽

10.1161/circ.142.suppl_3.14827 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Adeel Jamil ◽

Umer Jamil ◽

Suraj Dahal ◽

Vamsikrishna Gunnam ◽

Homa Najafi ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cohort Studies ◽

Meta Analysis ◽

Preliminary Evidence ◽

Vein Thrombosis ◽

Increased Risk ◽

Registration Number ◽

The Difference ◽

Prophylactic Anticoagulation ◽

D Dimer

Introduction: Preliminary evidence indicates that prophylactic-dosing thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19) patients, and the usefulness of D-dimer measurement as a biomarker for VTE risk classification in this setting remains unclear. The study aimed to estimate the incidence of VTE and examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. Methods: This study was conducted in accordance with the PRISMA guidelines, and the protocol was registered in PROSPERO (Registration Number: CRD42020189192). A comprehensive literature search of PubMed from inception to May 2020 was performed to harvest original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism [PE] or deep vein thrombosis [DVT]), PE, DVT, and mortality. Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval [CI], 16.2% to 33.7%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%) and 11.9% (95% CI, 6.3% to 21.3%) of patients, respectively. Patients in the intensive care unit had a higher risk for VTE (30.4% [95% CI, 19.6% to 43.9%]) than those in the ward (13.0% [95% CI, 5.9% to 26.3%]). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 μg/mL; 95% CI, 0.30 to 3.80 μg/mL; P=0.02). Conclusions: Heightened risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on optimal thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.

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