Thromb Haemost 1992; 67(05): 510-513
DOI: 10.1055/s-0038-1648483
Original Articles
Schattauer GmbH Stuttgart

The Use of the D-Dimer Test in Combination with Non-Invasive Testing Versus Serial Non-Invasive Testing Alone for the Diagnosis of Deep-Vein Thrombosis

Harriët Heijboer
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Jeffrey S Ginsberg
2   Department of Medicine, McMaster University, Hamilton, Canada
,
Harry R Büller
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Anthonie W A Lensing
2   Department of Medicine, McMaster University, Hamilton, Canada
,
Louisa P Colly
3   Thrombosis Service, Amsterdam, The Netherlands
,
Jan Wouter ten Cate
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 30. August 1991

Accepted after revision 10. Dezember 1991

Publikationsdatum:
03. Juli 2018 (online)

Summary

We studied the usefulness of the determination of plasma D-dimer levels (using an ELISA) in combination with non-invasive testing with impedance plethysmography (IPG) or real-time ultrasonography (US) for the diagnosis of deep-vein thrombosis (DVT), in outpatients with clinically suspected DVT This combined approach was compared to serial non-invasive testing alone in these patients. The sensitivity of a positive D-dimer test (>300 μg/1) for the presence of DVT was 100% (70/70 patients; 95% C. I.: 95-100%), whereas the specificity was 29% (69/ 239 patients; 95% C. I.: 23-34%). The proportion of patients in which a definitive decision about the presence or absence of DVT could be made on the day of referral, was calculated for both approaches. When applying the combined approach, in 42% of all referred patients the diagnosis of DVT could either be established or refuted on entry, as opposed to only 19% of patients using serial non-invasive testing alone.

Also, the costs per DVT diagnosed were calculated for the two diagnostic approaches. For the diagnosis of DVT the costs using serial IPG were comparable to the costs using the combination of IPG and the D-dimer test. The same conclusion holds for the comparison of serial US with the combination of US and D-dimer testing.

We conclude that for the diagnosis of DVT in symptomatic outpatients the combination of non-invasive testing with the D-dimer test might be preferred over serial non-invasive testing alone, although the safety of such an approach remains to be established in future management studies.

 
  • References

  • 1 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-144
  • 2 Bettman MA, Robbins A, Braun SD, Wetzner S, Dunnick NR, Finkelstein J. Contrast venography of the leg: diagnostic efficacy, tolerance and complication rates with ionic and non-ionic contrast media. Radiology 1987; 165: 113-116
  • 3 Hull RD, van Aken WG, Hirsh J, Gallus AS, Hoicka G, Turpie AGG, Walker I, Gent M. Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis. Circulation 1976; 53: 696-700
  • 4 Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Biiller HR, Turpie AGG, Powers P, Kinch D, Dodd PE, Gill GJ, Leclerc JR, Gent M. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann Intern Med 1985; 102: 21-28
  • 5 Dauzat MM, Laroche JP, Charras C. Real-time B-mode ultrasonography for better specificity in the noninvasive diagnosis of deep venous thrombosis. J Ultrasound Med 1986; 5: 625-631
  • 6 Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, Krekt J, ten Cate JW, Huisman MV, Biiller HR. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342-345
  • 7 Lensing AWA, Levi M, Biiller HR, Prandoni P, Agnelli G, ten Cate JW. An objective Doppler method for the diagnosis of deep-vein thrombosis. Ann Intern Med 1990; 113: 9-14
  • 8 Huisman MV, Biiller HR, ten Cate JW, Vreeken J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. The Amsterdam general practitioner study. N Engl J Med 1986; 314: 823-828
  • 9 Heijboer H, Brandjes DPM, Lensing AWA, Biiller HR, ten Cate JW. Efficacy of real-time B-mode ultrasonography in the diagnosis of deep-vein thrombosis in symptomatic outpatients. Thromb Haemo-stas 1991; 65 (06) 804 (Abstr)
  • 10 Whitaker AN, Elms MJ, Masci PP, Bundesen PG, Rylatt DB, Webber AJ, Bunce IH. Measurement of cross linked fibrin derivatives in plasma: an immunoassay using monoclonal antibodies. J Clin Pathol 1984; 37: 882-887
  • 11 Heaton DC, Billings JD, Hickton CM. Assessment of D dimer assays for the diagnosis of deep vein thrombosis. J Lab Clin Med 1987; 110: 588-591
  • 12 Rowbotham BJ, Carroll P, Whitaker AN, Bunce IH, Cobcroft RG, Elms MJ, Masci PP, Bundesen PG, Rylatt DB, Webber AJ. Measurement of crosslinked fibrin derivatives - use in the diagnosis of venous thrombosis. Thromb Haemostas 1987; >57 (01) 59-61
  • 13 Ott P, Astrup L, Jensen RH, Nyeland B, Pederson B. Assessment of D-dimer in plasma: Diagnostic value in suspected deep venous thrombosis of the leg. Acta Med Scand 1988; 224: 263-267
  • 14 Bounameaux H, Schneider PA, Reber G, de Moerloose Ph, Krahen-buhl B. Measurement of plasma D-dimer for diagnosis of deep venous thrombosis. Am J Clin Pathol 1989; 91: 82-85
  • 15 Wilde JT, Kitchen S, Kinsey S, Greaves M, Preston FE. Plasma D-dimer levels and their relationship to serum fibrinogen/fibrin degradation products in hypercoagulable states. Br J Haematol 1989; 71: 65-70
  • 16 Hunt FA, Rylatt DB, Hart RA, Bundesen PG. Serum crosslinked fibrin (XDP) and fibrinogen/fibrin degradation products (FDP) in disorders associated with activation of the coagulation or fibrinolytic systems. Br J Haematol 1985; 60: 715-722
  • 17 Bounameaux H, Cirafici P, de Moerloose P. et al Measurement of D-dimer in plasma as diagnostic aid in suspected pulmonary embolism. Lancet 1991; 337: 196-200
  • 18 Metz CE. Basic principles of ROC analysis. Semin Nucl Med 1978; 8: 283-298
  • 19 Huisman MV, Biiller HR, ten Cate JW. Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis. Arch Intern Med 1988; 148: 681-683
  • 20 Sackett DL, Haynes RB, Tugwell P. Clinical Epidemiology. A Basic Science for Clinical Medicine. First edition. Little, Brown and Company; Boston: 1985. pp 59-138