Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism

被引:66
作者
Le Gal, G
Righini, M
Roy, PM
Sanchez, O
Aujesky, D
Perrier, A
Bounameaux, H
机构
[1] Brest Univ Hosp, Dept Internal Med & Chest Dis, Brest, France
[2] Univ Hosp Geneva, Div Angiol & Hemostasis, Geneva, Switzerland
[3] Univ Hosp Geneva, Dept Internal Med, Div Gen Internal Med, Geneva, Switzerland
[4] Fac Med, Geneva, Switzerland
[5] Angers Univ Hosp, Emergency Dept, Angers, France
[6] Hop Europeen Georges Pompidou, Serv Pneumol, Paris, France
[7] Univ Lausanne Hosp, Dept Med, Lausanne, Switzerland
关键词
D O I
10.1001/archinte.166.2.176
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. Methods: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. Results: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous. VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery. Conclusions: In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.
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页码:176 / 180
页数:5
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