Different accuracies of rapid enzyme-linked immunosorbent, turbidimetric, and agglutination D-Dimer assays for thrombosis exclusion: impact on diagnostic work-ups of outpatients with suspected deep vein thrombosis and pulmonary embolism
| Autor: | Paul H. Trienekens, Marianne De Maeseneer, Hoogsteden H, Alain Gadisseur, Wilfried Schroyens, Jan Jacques Michiels, Peter M. P. Pattynama, Marc van der Planken, Jan T. Hermsen |
|---|---|
| Přispěvatelé: | Hematology, Pulmonary Medicine, Radiology & Nuclear Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
Enzyme-Linked Immunosorbent Assay Fibrin Fibrinogen Degradation Products Nephelometry and Turbidimetry Predictive Value of Tests D-dimer medicine Humans cardiovascular diseases Medical diagnosis Ultrasonography Venous Thrombosis Clinical Trials as Topic medicine.diagnostic_test business.industry Ventilation/perfusion scan Hematology Hemagglutination Tests Phlebography medicine.disease Thrombosis Spiral computed tomography Pulmonary embolism Venous thrombosis Predictive value of tests Radiology Cardiology and Cardiovascular Medicine business Pulmonary Embolism Tomography Spiral Computed Algorithms Blood Chemical Analysis |
| Zdroj: | Seminars in thrombosis and hemostasis Seminars in Thrombosis and Hemostasis, 32(7), 678-693. Thieme Medical Publishers |
| ISSN: | 0094-6176 |
| Popis: | The requirement for a safe diagnostic strategy should be based on an overall posttest incidence of venous thromboembolism (VTE) of less than 1%, with a negative predictive value of more than 99 to 100% during 3-month follow-up. Compression ultrasonography (CUS) and spiral computed tomography (CT) currently are the methods of choice to confirm or rule out deep venous thrombosis (DVT) and pulmonary embolism (PE), respectively. CUS has a negative predictive value (NPV) of 97 to 98%, indicating the need to improve the diagnostic work-up of patients with suspected DVT by clinical score assessment and D-dimer testing. Spiral CT as a stand-alone method detects all clinically relevant PEs and a large number of alternative diagnoses. It rules out PE with a NPV of 98 to 99%. Spiral CT is expensive, emphasizing the need to improve the diagnostic work-up of patients with suspected PE by the use of clinical score assessment and D-dimer testing. Clinical score assessment for DVT and PE has not safely ruled out VTE in multicenter studies and in routine daily practices. Modification of the Wells clinical score assessment for DVT by elimination of the "minus 2 points" for alternative diagnosis will improve the reproducibility of the clinical score assessment. The combination of a first negative CUS and a negative SimpliRed or an enzyme-linked immunosorbent assay (ELISA) VIDAS D-dimer of1,000 ng/mL safely exclude DVT (NPV99%) irrespective of clinical score assessment and without the need to repeat CUS in approximately 60 to 70% of patients. The rapid quantitative and qualitative agglutination D-dimer assays for the exclusion of VTE are not sensitive enough as stand-alone tests and should be used in combination with clinical score assessment. A normal rapid ELISA VIDAS D-dimer test as a stand-alone test safely excludes DVT and PE, with a NPV of 99 to 100%, irrespective of clinical score, without the need of CUS or spiral CT. The combined strategy of a rapid ELISA VIDAS D-dimer followed by objective testing with CUS for DVT and by spiral CT for PE will reduce the need for noninvasive imaging techniques by 40 to 50%. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|