VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism

Marc Carrier; Marc Righini; Reza Karami Djurabi; Menno V. Huisman; Arnaud Perrier; Philip S. Wells; Marc Rodger; Walter A. Wuillemin; Grégoire Le Gal

doi:10.1160/TH-08-10-0689

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(05): 886-892
DOI: 10.1160/TH-08-10-0689

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism

A systematic review of management outcome studies

Marc Carrier

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

²Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

,

Marc Righini

³Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland

,

Reza Karami Djurabi

⁴Section of Vascular Medicine, Department of General Internal Medicine – Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

,

Menno V. Huisman

⁴Section of Vascular Medicine, Department of General Internal Medicine – Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

,

Arnaud Perrier

⁵Division of General Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland

,

Philip S. Wells

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

²Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

,

Marc Rodger

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

²Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

,

Walter A. Wuillemin

⁶Division of Haematology and Central Haematology Laboratory Kantonsspital, Lucerne, and University of Berne Switzerland

,

Grégoire Le Gal

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

⁷Department of Internal Medicine and Chest Diseases, EA3878, Brest University Hospital, Brest, France

› Author Affiliations

Abstract

Summary

Clinical outcome studies have shown that it is safe to withhold anticoagulant therapy in patients with suspected pulmonary embolism (PE) who have a negative D-dimer result and a low pre-test probability (PTP) either using a PTP model or clinical gestalt. It was the objective of the present study to assess the safety of the combination of a negative VIDAS^© D-dimer result in combination with a non-high PTP using the Wells or Geneva models to exclude PE. A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Seven studies (6 prospective management studies and 1 randomised controlled trial) reporting failure rates at three months were included in the analysis. Non-high PTP was defined as “unlikely” using the Wells’ model, or “low/intermediate” PTP using either the Geneva score, the Revised Geneva Score, or clinical gestalt. Two reviewers independently extracted data onto standardised forms. A total of 5,622 patients with low/intermediate or unlikely PTP were assessed using the VIDAS D-dimer. PE was ruled out by a negative D-dimer test in 2,248 (40%, 95% confidence intervals [CI] 38.7 to 41.3%) of them. The three-month thromboembolic risk in patients left untreated on the basis of a low/intermediate or unlikely PTP and a negative D-dimer test was 3/2,166 (0.14%, 95% CI 0.05 to 0.41%). In conclusion, the combination of a negative VIDAS D-dimer result and a non-high PTP effectively and safely excludes PE in an important proportion of outpatients with suspected PE.

Keywords

D-dimer - diagnosis - management study - predictive value of tests - venous thromboembolism

Full Text

References

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