title: The usefulness of five D-dimer assays in the exclusion of deep venous thrombosis.
abstract: D-Dimer measurement is a promising tool in the exclusion of venous thrombosis. New d-dimer assays have been introduced, but need clinical validation. Our objective was to evaluate the clinical usefulness of four relatively new d-dimer assays and a classical ELISA in outpatients suspected for deep venous thrombosis. In 537 patients, participants in a large prospective management study using a clinical probability score and a d-dimer measurement (Tina-quant), additional samples were taken for d-dimer measurement using the Asserachrom ELISA, the VIDAS New, the STA-LIA and the Miniquant assay. Performances of each test were calculated using clinical data during a 3-month follow-up. Thrombosis was detected in 224 patients (42%). The area under the ROC curve was significantly higher for the Tina-quant as compared to the other assays. Using standard cut-off values, sensitivity, negative predictive value (NPV) and specificity of the Asserachrom were 97, 94 and 33%, respectively. For the VIDAS New, values were 100, 96 and 8%, respectively. The Tina-quant showed values of 99, 98 and 41%, respectively, and the STA-LIA 98, 95 and 32%. Values for the Miniquant were 95, 94 and 52%. The d-dimer assays in our study all show a high sensitivity and negative predictive value, but none of the assays reached an NPV of > 98% at standard cut-off values. d-Dimer assays with a low specificity still necessitate additional diagnostic tests in the majority of the patients.
authors.affiliation: Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands. schutgensvos@hetnet.nl
authors.forename: R E G
authors.initials: RE
authors.lastname: Schutgens
authors.forename: F J L M
authors.initials: FJ
authors.lastname: Haas
authors.forename: W B M
authors.initials: WB
authors.lastname: Gerritsen
authors.forename: F
authors.initials: F
authors.lastname: van der Horst
authors.forename: H K
authors.initials: HK
authors.lastname: Nieuwenhuis
authors.forename: D H
authors.initials: DH
authors.lastname: Biesma
mesh_terms: D003937:Diagnosis, Differential; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007118:Immunoassay / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic / Q000592:standards; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D011933:Reagent Kits, Diagnostic; C036309:fibrin fragment D