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CC BY 4.0 · TH Open 2019; 03(01): e2-e9
DOI: 10.1055/s-0038-1677029
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Highly Elevated Quantitative D-Dimer Assay Values Increase the Likelihood of Venous Thromboembolism

Samuel Francis
1   Division of Emergency Medicine, Duke University Hospital, Durham, North Carolina, United States
,
Alexander Limkakeng
1   Division of Emergency Medicine, Duke University Hospital, Durham, North Carolina, United States
,
Hui Zheng
2   Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Judd Hollander
3   Department of Emergency Medicine, Jefferson University, Philadelphia, Pennsylvania, United States
,
Gregory Fermann
4   Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, United States
,
Blair Alden Parry
5   Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Frank Lovecchio
6   Department of Emergency Medicine, Maricopa Hospital, Phoenix, Arizona, United States
,
Nikos Werner
7   International Center for Cardiovascular Interventions, Heart Center Bonn, Medizinischen Klinik und Poliklinik II, Bonn, Germany
,
Sebastian Schellong
8   Städtisches Klinikum Dresden, Medizinische Klinik, Dresden, Germany
,
Christopher Kabrhel
5   Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

30 April 2018

29 November 2018

Publication Date:
07 January 2019 (online)

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Abstract

Objectives In patients with suspected venous thromboembolism (VTE), the D-dimer assay is commonly utilized as part of the workup. The assay is primarily used to determine whether to proceed with radiographic imaging. We compared D-dimer levels in patients suspected of having VTE. We hypothesized that higher D-dimer values predict a higher likelihood of subsequent VTE diagnosis.

Methods We conducted a secondary analysis of a multinational, prospective observational study of low- to intermediate-risk adult patients presenting to the emergency department with suspicion of VTE. Demographic and clinical data were collected in a structured manner. Advanced imaging including ultrasound, computed tomography (CT) pulmonary angiography, and ventilation/perfusion scanning was obtained at the discretion of the treating physicians. Imaging was evaluated by board-certified radiologists in real time. D-dimer values' bins were evaluated using a logistic regression model.

Results We evaluated 1,752 patients for suspected deep vein thrombosis (DVT), with 191 (10.4%) DVT positive. We evaluated 1,834 patients for suspected pulmonary embolism (PE), with 108 (5.9%) PE positive. Higher D-dimer values in both groups were associated with higher likelihood of subsequent VTE diagnosis, with D-dimer values > 3,999 ng/mL in both groups having the highest incidence of VTE. More than 50% of those patients were VTE positive.

Conclusions Increasing D-dimer values predict increased likelihood of being found VTE positive in this patient population. Among those in the highest D-dimer category, > 3,999 ng/mL, over half of patients were VTE positive. Further research could determine additional nuance in D-dimer as a tool to work up suspected VTE.

Keywords

venous thrombosis - deep vein thrombosis - pulmonary embolism

Note

Data originally presented at American College of Emergency Physicians (ACEP) Scientific Assembly 2017, Washington DC. Plenary Abstract #12, October 31, 2017. Abstract title: Highly Elevated Quantitative D-Dimer Assay Values Increase the Likelihood of Venous Thromboembolism.


 

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