Rational use of D-dimer measurement to exclude acute venous thromboembolic disease.
Clinical diagnosis of venous thromboembolic (VTE) disease is often inaccurate because signs and symptoms are nonspecific. Testing for the absence of D-dimer levels in the blood of patients with suspected deep venous thrombosis and pulmonary embolism can assist in ruling out these illnesses. Some highly sensitive D-dimer assays have sufficient specificity to assist in the exclusion of VTE disease. Numerous clinical management trials using D-dimer measurement in association with additional diagnostic tests have shown that it is safe to withhold anticoagulant therapy in selected patients with suspected VTE disease who have negative D-dimer assay results. Applying these diagnostic strategies can potentially decrease the need for radiological testing. The simplicity of measuring D-dimer levels creates the potential for misuse. For safe patient management, clinicians must understand the indications for and limitations of D-dimer measurement in the diagnosis of VTE disease.
Frost
Shaun D
SD
Section of Hospital Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. frosts@ccf.org
Brotman
Daniel J
DJ
Michota
Franklin A
FA
D000933:Antifibrinolytic Agents / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005338:Fibrin Fibrinogen Degradation Products / Q000096:biosynthesis / Q000378:metabolism*; D006801:Humans; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis; D015203:Reproducibility of Results; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D