D-Dimer Determination to Exclude Pulmonary Embolism: a Two-Step Approach Using Latex Assay as a Screening Tool

Summary

D-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests. We tested this hypothesis by comparing DD levels measured by ELISA and latex assays in 334 patients suspected of pulmonary embolism. All but one patient with a positive (DD ≥500 ng/ml) latex assay had DD levels higher than 500 ng/ml with the ELISA assay. Accordingly, ELISA technique could be restricted to patients with a negative result in latex assay. This two-step approach would have spared about 50% of ELISA in our cohort. In conclusion, our data indicate that a latex test can be used as a first diagnostic step to rule out pulmonary embolism provided a negative result is confirmed by ELISA and the performance of the latex assay used has been assessed properly.

• References

• 1 Bounameaux H, de Moerloose P, Perrier A, Reber G. Plasma measurement of D-Dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost 1994; 71: 1-6
• 2 Rowbotham BJ, Egerton-Vernon J, Whitaker AN, Elms MJ, Bunce IH. Plasma cross linked fibrin degradation products in pulmonary embolism. Thorax 1990; 45: 684-687
• 3 Lichey J, Reschofski I, Dissmann T, Priesnitz M, Hoffmann M, Lode H. Fibrin degradation product D-dimer in the diagnosis of pulmonary embolism. Klin Wschr 1991; 69: 522-526
• 4 Harrison KA, Haire WD, Pappas AA, Purnell GL, Palmer S, Holdeman KP, Fink LM, Dalrymple GV. Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus. J Nucl Med 1993; 34: 896-898
• 5 van Beek EJR, van den Ende B, Berckmans RJ, van der Heide Y, Brandjes DPM, Sturk A, ten Cate JW. A comparative analysis of D-Dimer assays in patients with clinically suspected pulmonary embolism. Thromb Haemost 1993; 70: 408-413
• 6 Goldhaber SZ, Simons GR, Elliott CG, Haire WD, Tolztis R, Blacklow SC, Doolittle MH, Weinberg DS. Quantitative plasma D-Dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism. JAMA 1993; 270: 2819-2822
• 7 Bounameaux H, Cirafici P, de Moerloose P, Schneider PA, Slosman D, Reber G, Unger PF. Measurement of D-dimer in plasma as diagnostic aid in suspected pulmonary embolism. Lancet 1991; 337: 196-200
• 8 Perrier A, Bounameaux H, Morabia A, de Moerloose P, Unger PF, Slosman D, Junod AF. Contribution of plasma D-Dimer and lower limb venous ultrasound to the diagnosis of pulmonary embolism: a decision analysis. Am Heart J 1994; 127: 624-635
• 9 Reber G, de Moerloose P, Minazio P, Bounameaux H. Comparison of two new latex assays for D-Dimer with an ELISA method. Thromb Haemost 1993; 69: 839 (abstract)