Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy.

Abstract : D-dimer testing is useful for the exclusion of acute venous thromboembolism (VTE). Anticoagulant therapy is expected to reduce D-dimer levels in patients with thrombosis and, consequently, it may not be safe to use D-dimer levels to exclude VTE after anticoagulant therapy has been started. The objectives of this study were to estimate the decrease in D-dimer levels after 24 h of heparin therapy and, applying this estimate to the results of a recent study, to calculate the expected reduction in sensitivity. Using pre-defined criteria, we first performed a literature review to determine whether, and by how much, D-dimer levels decrease within 24 h of starting heparin therapy in patients with acute VTE. Using D-dimer levels that were measured in a prospective study of patients with confirmed deep vein thrombosis and/or pulmonary embolism as baselines, we then determined the change in sensitivity (and specificity) that would result from the fall in D-dimer levels that the literature review suggested would have occurred after 24 h of heparin therapy. On the basis of the literature review, we calculated that mean D-dimer levels decrease by 25%, 24 h after starting heparin therapy in patients with acute VTE. This 25% decrease in D-dimer levels resulted in a decrease in sensitivity from 95.6% (95% confidence interval, 90.0-98.6) to 89.4% (95% confidence interval, 83.7-95.1). There is a decrease in D-dimer levels in patients with acute VTE 24 h after starting heparin therapy that is expected to result in a clinically important drop in sensitivity.
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Article dans une revue
Blood Coagulation and Fibrinolysis, Lippincott, Williams & Wilkins, 2002, 13 (3), pp.241-6
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http://hal.univ-brest.fr/hal-00722287
Contributeur : Ghislaine Calvez <>
Soumis le : mercredi 1 août 2012 - 11:03:40
Dernière modification le : mercredi 10 janvier 2018 - 14:42:02

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  • HAL Id : hal-00722287, version 1
  • PUBMED : 11943938

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Francis Couturaud, Clive Kearon, S. M. Bates, J. S. Ginsberg. Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy.. Blood Coagulation and Fibrinolysis, Lippincott, Williams & Wilkins, 2002, 13 (3), pp.241-6. 〈hal-00722287〉

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