Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism.

Abstract : BACKGROUND: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. METHODS: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery. CONCLUSIONS: In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.
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Archives of Internal Medicine -New Series-, American Medical Association, 2006, 166 (2), pp.176-80. 〈10.1001/archinte.166.2.176〉
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Soumis le : jeudi 19 avril 2012 - 11:57:30
Dernière modification le : mercredi 10 janvier 2018 - 14:42:02

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Grégoire Le Gal, Marc Righini, Pierre-Marie Roy, Oliver Sanchez, Drahomir Aujesky, et al.. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism.. Archives of Internal Medicine -New Series-, American Medical Association, 2006, 166 (2), pp.176-80. 〈10.1001/archinte.166.2.176〉. 〈hal-00689064〉

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