Deep vein thrombosis laboratory tests: Difference between revisions
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The lifetime incidence of [[DVT]] ranges from 2-5% in general population. It accounts for a large number of ER visits and puts the patient at-risk for life-threatening [[pulmonary embolism]]. The use of D-dimer after assessment of pre-test probability has been widely validated now and has led to a significant reduction in unnecessary procedures in the ER and hospital settings. This chapter will review the role of D-dimer in diagnosis of [[DVT]]. For detailed discussion on D-dimer, please visit '''{{main|d-dimer}}'''. | The lifetime incidence of [[DVT]] ranges from 2-5% in general population. It accounts for a large number of ER visits and puts the patient at-risk for life-threatening [[pulmonary embolism]]. The use of D-dimer after assessment of pre-test probability has been widely validated now and has led to a significant reduction in unnecessary procedures in the ER and hospital settings. This chapter will review the role of D-dimer in diagnosis of [[DVT]]. For detailed discussion on D-dimer, please visit '''{{main|d-dimer}}'''. | ||
==D-dimer== | |||
In a low-probability situation, current practice is to commence investigations by testing for [[D-dimer]] levels. This cross-linked [[fibrin degradation product]] is an indication that [[thrombosis]] is occurring, and that the [[blood clot]] is being dissolved by [[plasmin]]. A low D-dimer level should prompt other possible [[Deep vein thrombosis differential diagnosis|diagnoses]] (such as a ruptured [[Baker's cyst]], if the patient is at sufficiently low clinical probability of DVT.<ref name="pmid14507948">{{cite journal |author=Wells PS, Anderson DR, Rodger M, ''et al'' |title=Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis |journal=N. Engl. J. Med. |volume=349 |issue=13 |pages=1227-35 |year=2003 |pmid=14507948 |doi=10.1056/NEJMoa023153}}</ref><ref name="pmid12755550">{{cite journal |author=Bates SM, Kearon C, Crowther M, ''et al'' |title=A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis |journal=Ann. Intern. Med. |volume=138 |issue=10 |pages=787-94 |year=2003 |pmid=12755550 |doi=}}</ref> | In a low-probability situation, current practice is to commence investigations by testing for [[D-dimer]] levels. This cross-linked [[fibrin degradation product]] is an indication that [[thrombosis]] is occurring, and that the [[blood clot]] is being dissolved by [[plasmin]]. A low D-dimer level should prompt other possible [[Deep vein thrombosis differential diagnosis|diagnoses]] (such as a ruptured [[Baker's cyst]], if the patient is at sufficiently low clinical probability of DVT.<ref name="pmid14507948">{{cite journal |author=Wells PS, Anderson DR, Rodger M, ''et al'' |title=Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis |journal=N. Engl. J. Med. |volume=349 |issue=13 |pages=1227-35 |year=2003 |pmid=14507948 |doi=10.1056/NEJMoa023153}}</ref><ref name="pmid12755550">{{cite journal |author=Bates SM, Kearon C, Crowther M, ''et al'' |title=A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis |journal=Ann. Intern. Med. |volume=138 |issue=10 |pages=787-94 |year=2003 |pmid=12755550 |doi=}}</ref> | ||
It should be noted that latex D-dimer assays are insensitive and have no role in screening for deep vein thrombosis. | It should be noted that latex D-dimer assays are insensitive and have no role in screening for deep vein thrombosis. | ||
Revision as of 14:33, 18 May 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS[1]; Kashish Goel, M.D.
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Overview
The lifetime incidence of DVT ranges from 2-5% in general population. It accounts for a large number of ER visits and puts the patient at-risk for life-threatening pulmonary embolism. The use of D-dimer after assessment of pre-test probability has been widely validated now and has led to a significant reduction in unnecessary procedures in the ER and hospital settings. This chapter will review the role of D-dimer in diagnosis of DVT. For detailed discussion on D-dimer, please visit
.
D-dimer
In a low-probability situation, current practice is to commence investigations by testing for D-dimer levels. This cross-linked fibrin degradation product is an indication that thrombosis is occurring, and that the blood clot is being dissolved by plasmin. A low D-dimer level should prompt other possible diagnoses (such as a ruptured Baker's cyst, if the patient is at sufficiently low clinical probability of DVT.[1][2]
It should be noted that latex D-dimer assays are insensitive and have no role in screening for deep vein thrombosis.
References
- ↑ Wells PS, Anderson DR, Rodger M; et al. (2003). "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis". N. Engl. J. Med. 349 (13): 1227–35. doi:10.1056/NEJMoa023153. PMID 14507948.
- ↑ Bates SM, Kearon C, Crowther M; et al. (2003). "A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis". Ann. Intern. Med. 138 (10): 787–94. PMID 12755550.