Clinical studyLimitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism☆
Section snippets
Design and subjects
We conducted a prospective study of patients at Johns Hopkins Hospital who underwent radiologic evaluation for possible venous thromboembolism. The hospital’s institutional review board approved the protocol; informed consent was obtained from all participants. We identified patients by daily review (weekdays only) of radiology scheduling records. Attempts were made to enroll all eligible patients. Any patient who underwent radiologic evaluation for deep vein thrombosis or pulmonary embolism
Results
Subjects were enrolled between November 1999 and December 2000. Of the 250 patients enrolled, laboratory tests and appropriate radiographic studies were completed for 203 patients (81%). Forty-five patients (22%) had thrombosis by radiographic imaging, including pulmonary embolism in 21 patients, deep vein thrombosis alone in 20 patients, and both conditions in 4 patients. Thrombosis was diagnosed by helical CT scan alone in 16 patients, ultrasound examination alone in 18, autopsy in 1,
Discussion
We found that D-dimer testing has limited utility for the exclusion of venous thromboembolism in unselected hospitalized patients, especially in the elderly and in those who have been hospitalized for more than 3 days. The three non-ELISA tests were not useful in distinguishing patients with thrombosis from those without thrombosis among patients 60 years of age or older, or who had been hospitalized for more than 3 days; in other words, a negative D-dimer test did not lower the probability of
Acknowledgements
We thank Rosa Sebree, Jeffrey Mendoza, and Dawn Clark for subject enrollment and chart review; Esther Lipsky for her technical assistance; and Elliot Fishman, Elrike Hamper, Karen Horton, and Richard Rothman for their willingness to facilitate patient enrollment.
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Dr. Brotman is currently with the Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
This study was supported by funding from the Dade Behring Corporation, Marburg, Germany.