Selective D-dimer testing for the diagnosis of acute deep vein thrombosis -A validation study.
J Thromb Haemost. 2013 Oct 1;
Authors: van der Hulle T, Tan M, den Exter PL, C Mol G, Iglesias Del Sol A, van de Ree MA, Huisman MV, Klok FA
Abstract
The standard diagnostic algorithm for patients with clinically suspected deep vein thrombosis (DVT) starts with the Wells rule to determine pre-test probability followed by a quantitative D-dimer test in case of an unlikely clinical probability[1,2]. In patients with a 'DVT unlikely' score (0-1 point) and a D-dimer level <0.5 μg/mL DVT can be safely ruled out[1,3,4]. In the remaining patients a proximal lower limb compression ultrasonography (CUS) is indicated. For patients with a 'DVT likely' score (≥2 points) and a normal CUS, a subsequently assessed D-dimer level ≥0.5 μg/mL is an indication for a repeated CUS after one week[2]. This strategy has high sensitivity but low specificity, resulting in a high number of CUS negative for DVT[2,4]. One of the main challenges in improving this algorithm is to safely diminish the number of required CUS. This article is protected by copyright. All rights reserved.
PMID: 24119063 [PubMed - as supplied by publisher]