title: D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis.
abstract: BACKGROUND
  D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT).
  
  
  OBJECTIVE
  To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT.
  
  
  METHODS
  We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: ≤500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism.
  
  
  RESULTS
  We enrolled 239 patients (F: 63.6%; mean±SD age: 58.3±16.8). At the initial diagnostic work-up, DVT was detected in 24 (10%) patients while SVT in 35 (14.6%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92% (95%CI: 73-99%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 98% (95%CI: 93-100%), whereas for SVT they were 77% (95%CI: 59-89%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 93% (95%CI: 86-97%).
  
  
  CONCLUSIONS
  D-dimer has a negative predictive value ≥93% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT.
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy. Electronic address: michelangelo.sartori@aosp.bo.it.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Sartori
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Ludovica
authors.initials: L
authors.lastname: Migliaccio
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Favaretto
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Cini
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Legnani
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.affiliation: Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
authors.forename: Benilde
authors.initials: B
authors.lastname: Cosmi
mesh_terms: D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Diagnosis; Superficial vein thrombosis; Ultrasonography; Ultrasound imaging; Upper extremity deep vein thrombosis