Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism

Détails

ID Serval
serval:BIB_3EF88C60219B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism
Périodique
Archives of Internal Medicine
Auteur⸱e⸱s
Le Gal  G., Righini  M., Roy  P. M., Sanchez  O., Aujesky  D., Perrier  A., Bounameaux  H.
ISSN
0003-9926 (Print)
Statut éditorial
Publié
Date de publication
01/2006
Volume
166
Numéro
2
Pages
176-80
Notes
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Jan 23
Résumé
BACKGROUND: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. METHODS: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery. CONCLUSIONS: In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.
Mots-clé
Adult Aged Anticoagulants/*therapeutic use Biological Markers/analysis Cohort Studies Diagnosis, Differential Disease Susceptibility Emergency Service, Hospital Female Fibrin Fibrinogen Degradation Products/*analysis Follow-Up Studies Humans Male Middle Aged Predictive Value of Tests Probability Pulmonary Embolism/blood/*diagnosis/mortality Sensitivity and Specificity Severity of Illness Index Thromboembolism/*diagnosis/drug therapy/mortality
Pubmed
Web of science
Création de la notice
25/01/2008 13:38
Dernière modification de la notice
20/08/2019 13:35
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