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D‐Dimer for venous thromboembolism diagnosis: 20 years later
Author(s) -
RIGHINI M.,
PERRIER A.,
DE MOERLOOSE P.,
BOUNAMEAUX H.
Publication year - 2008
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2008.02981.x
Subject(s) - medicine , pulmonary embolism , d dimer , emergency department , deep vein , pre and post test probability , venous thromboembolism , venous thrombosis , radiology , thrombosis , population , thrombus , diagnostic test , intensive care medicine , pediatrics , surgery , environmental health , psychiatry
Summary. Twenty years after its first use in the diagnostic workup of suspected venous thromboembolism (VTE), fibrin D‐dimer (DD) testing has gained wide acceptance for ruling out this disease. The test is particularly useful in the outpatient population referred to the emergency department because of suspected deep vein thrombosis (DVT) or pulmonary embolism (PE), in which the ruling out capacity concerns every third patient clinically suspected of having the disease. This usefulness is based on the high sensitivity of the test to the presence of VTE, at least for some assays. Due to its poor specificity precluding its use for ruling in VTE, DD testing must be integrated in comprehensive, sequential diagnostic strategies that include clinical probability assessment and imaging techniques such as lower limb venous compression ultrasonography for suspected DVT or multi‐slice helical computed tomography for suspected PE. The present narrative review updates the data available on the use of the various commercially available DD assays in the diagnostic approach of clinically suspected VTE in distinct patient populations or situations, including outpatients and inpatients, patients with cancer, older age, pregnancy, a suspected recurrent event, limited thrombus burden, and patients already on anticoagulant treatment.