Whole blood D-dimer assay: an effective noninvasive method to rule out pulmonary embolism.
BACKGROUND
The whole blood D-dimer assay has gained recognition as a noninvasive test to rule out pulmonary embolism (PE) in medical patients.


METHODS
We performed a whole blood D-dimer assay in medical and surgical patients undergoing either pulmonary angiogram or pulmonary ventilation perfusion scan for suspected PE or duplex Doppler or venogram for suspected deep venous thrombosis (DVT).


RESULTS
A total of 483 patients were enrolled; 16 were excluded because of an equivocal pulmonary ventilation perfusion scan. The 467 remaining patients had a mean age of 56 +/- 27 years. There were 258 women and 209 men. A total of 353 patients were admitted to a medical service and 114 to surgery/ trauma. A total of 82 patients (18%) developed thromboembolism: 20 had PE, and 62 had DVT.


CONCLUSIONS
No surgical patient with PE or DVT (n = 27) had a negative D-dimer. A negative D-dimer result in a stable surgical patient should be considered conclusive evidence to rule out thromboembolism and, thus, negate the need for further diagnostic studies. In our surgical patients suspected of DVT or PE, had D-dimer been used, one third of the patients would have avoided an expensive or invasive diagnostic test.
Owings
J T
JT
Department of Surgery, University of California, Davis, Medical Center, Sacramento, USA.
Gosselin
R C
RC
Battistella
F D
FD
Anderson
J T
JT
Petrich
M
M
Larkin
E C
EC
D000368:Aged; D000792:Angiography; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D010690:Phlebography; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D014692:Ventilation-Perfusion Ratio
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D