Marc Carrier1,2; Marc Righini3; Reza Karami Djurabi4; Menno V. Huisman4; Arnaud Perrier5; Philip S. Wells1,2; Marc Rodger1,2; Walter A. Wuillemin6; Grégoire Le Gal1,7
1Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 2Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Section of Vascular Medicine, Department of General Internal Medicine – Endocrinology, Leiden University Medical Center, Leiden, the Netherlands; 5Division of General Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 6Division of Haematology and Central Haematology Laboratory Kantonsspital, Lucerne, and University of Berne Switzerland; 7Department of Internal Medicine and Chest Diseases, EA3878, Brest University Hospital, Brest, France
Clinical outcome studies have shown that it is safe to withhold anticoagulant therapy in patients with suspected pulmonary embolism (PE) who have a negative D-dimer result and a low pretest probability (PTP) either using a PTP model or clinical gestalt. It was the objective of the present study to assess the safety of the combination of a negative VIDAS© D-dimer result in combination with a non-high PTP using the Wells or Geneva models to exclude PE. A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Seven studies (6 prospective management studies and 1 randomised controlled trial) reporting failure rates at three months were included in the analysis. Non-high PTP was defined as “unlikely” using the Wells' model, or “low/intermediate” PTP using either the Geneva score, the Revised Geneva Score, or clinical gestalt. Two reviewers independently extracted data onto standardised forms. A total of 5,622 patients with low/intermediate or unlikely PTP were assessed using the VIDAS D-dimer. PE was ruled out by a negative D-dimer test in 2,248 (40%, 95% confidence intervals [CI] 38.7 to 41.3%) of them. The three-month thromboembolic risk in patients left untreated on the basis of a low/intermediate or unlikely PTP and a negative D-dimer test was 3/2,166 (0.14%, 95% CI 0.05 to 0.41%). In conclusion, the combination of a negative VIDAS D-dimer result and a non-high PTP effectively and safely excludes PE in an important proportion of outpatients with suspected PE.
Diagnosis, Predictive Value of Tests, venous thromboembolism, D-dimer, management study
Roger E. G. Schutgens1, Fred J. L. M. Haas2, Mariette J. Agterof3, Marike Vos1, Douwe H. Biesma3
Thromb Haemost 2007 97 5: 807-813
Mogens Tornby Stender1, Jens Brøndum Frøkjær2, Tina Sandie Hagedorn Nielsen2, Torben Bjerregaard Larsen3, Søren Lundbye-Christensen4, Henrik Elbrønd1, Ole Thorlacius-Ussing1
Thromb Haemost 2008 99 2: 396-400
I. Heller, M. Topilsky, I. Shapira, A. Isakov
Methods Inf Med 1999 38 3: 182-186
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