Abstract
D-dimer is a marker of thrombin and plasmin generation. The usefulness of D-dimer measurement as a negative predictive value in the exclusion of thromboembolic disease in patients with low or moderate clinical pretest has been demonstrated for some time. However, the appearance of new methodologies, which express the results in different units and have a different degree of approval for use in thromboembolic disease, exclusion algorithm has generated a degree of confusion. The objective of this review is to compile and disseminate the recommendations of the different international guidelines on the use of D-dimer in the diagnosis of thromboembolic disease. The different degrees of approval of the Food and Drug Administration are discussed for the laboratory methods (help in the diagnosis vs. exclusion), the units in which the results should be expressed, what information should be included when a D-dimer result is reported, how to establish the cut-off points of the different methods and in which patients the D-dimer assay can be used to exclude thromboembolic disease.
References
2. Righini M, Perrier A, De Moerloose P, Bounameaux H. D-Dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost. 2008;6: 1059-71.
3. Chan W-S, Lee A, Spencer FA, Chunilal S, Crowther M, Wu W, Johnston M, Rodger M, Ginsberg JS. D-dimer testing in pregnant patients: towards determining the next “level” in the diagnosis of deep vein thrombosis. J Thromb Haemost. 2010; 8: 1004-11.
4. CLSI Quantitative D-dimer for the Exclusion of Venous Thromboembolic Disease, approved guidelines 1st Edition, CLSI documents H59 A Wayne PA: Clinical Laboratory Standards Institute 2011.
5. College of American Pathologist Hematology and Coagulation HEM 37924/25/30/35. Checklist, 21/08/2017, pag 80-83.
6. Riley RS, Gilbert AR, Dalton JB, Pai S, McPherson RA. Widely Used Types and Clinical Applications of D-Dimer Assay. Laboratory Medicine. 2016;47: 90-102.
7. Lippi G, Tripodi A, Simundic AM, Favaloro EJ. International survey on D-dimer test reporting: a call for standardization. Semin thromb Hemost. 2015; 41:287-293.
8. Olson JD, Cunningham MT, Higgins RA, Eby CS, Brandt JT. D-dimer: simple test, tough problems. Arch Pathol Lab Med. 2013;1030-1038.
9. CLSI Collection, Trnasport and Processing of blood Specimens for testing plasma-based coagulation Assays and Molecular hemostasis Assays; approved guidelines, fifth Edition.CLSI
documents H21-A5 Wayne PA: Clinical Laboratory Standards Institute 2008.
10. Ruiz-Giménez N, Friera A, Artieda P et al. Rapid D-dimer test combined a clinical model for deep vein thrombosis. Validation with ultrasonography and clinical follow-up in 383 patients.
Thromb Haemost. 2004 ;91 ( 6 ): 1237-1246.
11. Di Nisio M, Squizzato A, Rutjes AW, Büller HR, Zwinderman AH, Bossuyt PM. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost. 2007 Feb;5(2):296-304.
12. Geersing GJ, Janssen KJ, Oudega R et al. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic
meta-analysis. BMJ. 2009;339:b2990.
13. Bates SM, Jaeschke R, Stevens SM, Goodacre
S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH.Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis,
9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e351S-e418S. doi: 10.1378/chest.11-2299.
14. Peñaloza A, Roy P-M, Kline J, Verschuren F, Le Gal G, Quentin-Georget S, Delvau N, Thys F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. J Thromb Haemost. 2012; 10: 1291-6.
15. Arnason T, Wells PS, Forster AJ. Appropriateness of diagnostic strategies for evaluating suspected venous thromboembolism. Thromb Haemost. 2007 Feb;97 (2):195-201.
16. Stein PD, Hull RD, Patel KC et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004; 140 (8): 589-602.
17. Lucassen W, Geersing GJ, Erkens PM et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 2011 Oct 4;155(7):448-60.
18. van Es N, van der Hulle T, van Es J et al. D-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data Meta-analysis. Ann Intern Med. 2016 Aug 16;165(4):253-61.
19. Bates SM, Takach Lapner S et al. Rapid quantitative D-dimer to exclude pulmonary embolism: a prospective cohort management study. J
Thromb Haemost. 2016 Mar;14(3):504-9.
20. van Es N, van der Hulle T, Büller HR et al. D-dimer testing safe to rule out acute pulmonary embolism? J Thromb Haemost. 2017 Feb;15(2):323-328.
21. Couturaud F, Kearon C, Bates SM, Ginsberg JS. Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy. Blood Coagul Fibrinolysis. 2002 Apr;13(3):241-6.
22. Fancher TL, White RH, Kravitz RL. Combined use of rapid D-dimer testing and estimation of clinical probability in the diagnosis of deep vein thrombosis: systematic review. BMJ. 2004 Oct 9;329(7470):821.
23. Takach Lapner S, Julian JA, Linkins LA, Bates SM, Kearon C. Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies. J Thromb Haemost. 2016 Oct;14(10):1953-1959.
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