Highlights
- •D-dimer is proposed as a stand-alone test to rule out deep vein thrombosis (DVT).
- •We retrospectively explored the safety and efficiency of such a strategy in a large cohort.
- •Our findings suggest that D-dimer as a stand-alone test may be safe for excluding proximal DVT.
- •This strategy has the potential to simplify and increase the efficiency of the diagnostic work-up.
Abstract
Background
Current guidelines recommend the use of clinical decision rules, such as Wells score,
in combination with D-dimer to assess the need for objective imaging to rule out deep
vein thrombosis (DVT). However, the clinical decision rule has limitations, and use
of D-dimer as a stand-alone test has been suggested.
Objective
We aimed to assess the safety and efficiency of D-dimer as a stand-alone test to rule
out DVT in outpatients referred with suspected DVT.
Methods
We collected data from consecutive outpatients referred to our hospital with suspected
DVT in 2008–2018. D-dimer levels were analyzed using STA® Liatest® D-Di assay. D-dimer
as a stand-alone test was theoretically applied in retrospect, and the number of misdiagnosed
events were estimated as if such an approach had been initially used. All patients
were followed for three months.
Results
Of 1765 included patients, 293 (16.6%) were diagnosed with DVT. A total of 491 patients
(27.8%) had a negative D-dimer (<500 ng/mL). Of these, nine were diagnosed with DVT,
yielding a failure rate for D-dimer as a stand-alone test of 1.8% (95% CI 0.8%–3.5%).
The majority of the misdiagnosed patients had distal DVT. In analyses restricted to
proximal DVTs, the failure rate was 0.6% (95% CI 0.1%–1.8%). D-dimer as a stand-alone
approach reduced the proportion of required ultrasounds from 81.8% to 72.2%.
Conclusion
D-dimer as a stand-alone test may be safe for excluding proximal DVT and reduce the
proportion of required ultrasounds. Prospective management studies are needed to confirm
our findings.
Keywords
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Article info
Publication history
Published online: April 25, 2020
Accepted:
April 20,
2020
Received in revised form:
April 14,
2020
Received:
December 14,
2019
Footnotes
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