Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview D-dimer and Thromboembolism Abnormal Levels Plasma D-dimer levels > 500 ng/mL are abnormal.[1]
Sensitivity and Specificity Sensitivity[1] ELISA (p=0.020) , quantitative rapid ELISA (p=0.016) and semi-quantitative ELISA (p=0.047) are shown to be statistically superior to whole-blood agglutination .
Specificity[1] Qualitative rapid ELISA has shown to be statistically superior to ELISA (p=0.004) , quantitative rapid ELISA (p=0.002) , semi-quantitative rapid ELISA (p=0.001) , quantitative (p=0.005) and semi-quantitative latex agglutination assays (p=0.019) .
Method
Sensitivity (95% CI)
Specificity (95% CI)
Positive Likelihood Ratio (95% CI)
Negative Likelihood Ratio (95% CI)
Time to obtain Results
Enzyme-linked immunosorbent assay (ELISA)
0.95 (0.85 to 1.00)
NS
NS
0.13 (0.03 to 0.58)
≥ 8 hours
Quantitative rapid ELISA
0.95 (0.83 to 1.00)
NS
NS
0.13 (0.02 to 0.84)
30 mins
Semi-Quantitative rapid ELISA
0.93 (0.79 to 1.00)
NS
NS
0.20 (0.04 to 0.96)
10 mins
Qualitative rapid ELISA
NS
0.68 (0.50 to 0.87)
NS
0.11 (0.01 to 0.93)
10 mins
Quantitative Latex Agglutination
NS
NS
NS
NS
10-15 mins
Semi-quantitative Latex Agglutination
NS
NS
NS
0.17 (0.04 to 0.78)
5 mins
Whole-Blood Agglutination
NS
0.74 (0.60 to 0.88)
NS
NS
2 mins
Hemodynamically Stable Patients Incidence of Thromboembolic Events in Hemodynamically Stable Patients
Condition
Incidence of thromboembolic event (%)
Patients not receiving anticoagulation with negative CT findings.
1.5%[2] [3]
Patients with a high d-dimer level
1.5%
Patients with a normal d-dimer level
0.5%[2]
Multidetector CT is indicated in hemodynamically stable patients with a high clinical probability of PE and/or patients with elevated plasma d-dimer levels secondary to the lack of specificity.[3] [4] In patients with low-to-moderate suspicion of PE, a normal D-dimer level is considered sufficient to exclude the possibility of pulmonary embolism.[5] [1] [6] Flowchart Summarizing the Role of D-dimer in the Diagnosis of PE
Patients with suspection of Pulmonary embolism
Clinically Low or Moderate
Clinically High
D-Dimer Positive
D-Dimer Negative
No treatment
Further Tests
Further Tests
[7]
References
↑ 1.0 1.1 1.2 1.3 Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, Biel RK, Bharadia V, Kalra NK (2004). "D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review". Annals of Internal Medicine 140 (8): 589–602. PMID 15096330 . ↑ 2.0 2.1 Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL; et al. (2005). "Multidetector-row computed tomography in suspected pulmonary embolism" . N Engl J Med . 352 (17): 1760–8. doi :10.1056/NEJMoa042905 . PMID 15858185 . in: J Fam Pract. 2005 Aug;54(8):653, 657 ↑ 3.0 3.1 van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW; et al. (2006). "Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography" . JAMA . 295 (2): 172–9. doi :10.1001/jama.295.2.172 . PMID 16403929 . ↑ Gupta RT, Kakarla RK, Kirshenbaum KJ, Tapson VF (2009). "D-dimers and efficacy of clinical risk estimation algorithms: sensitivity in evaluation of acute pulmonary embolism" . AJR Am J Roentgenol . 193 (2): 425–30. doi :10.2214/AJR.08.2186 . PMID 19620439 . ↑ Bounameaux H, de Moerloose P, Perrier A, Reber G (1994). "Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview". Thromb. Haemost . 71 (1): 1–6. PMID 8165626 . ↑ Bounameaux H, Perrier A, Righini M (2010). "Diagnosis of venous thromboembolism: an update" . Vasc Med . 15 (5): 399–406. doi :10.1177/1358863X10378788 . PMID 20926499 . ↑ Gosselin RC, Wu JR, Kottke-Marchant K, Peetz D, Christie DJ, Muth H; et al. (2012). "Evaluation of the Stratus® CS Acute Care™ D-dimer assay (DDMR) using the Stratus® CS STAT Fluorometric Analyzer: A prospective multisite study for exclusion of pulmonary embolism and deep vein thrombosis" . Thromb Res . doi :10.1016/j.thromres.2011.12.015 . PMID 22245223 .
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