D-dimer testing is useful to exclude deep vein thrombosis in elderly outpatients.

Marc Carrier 1, 2 Grégoire Le Gal 3 S. M. Bates 4 D. R. Anderson 5 P. S. Wells 6, *
* Auteur correspondant
1 Thrombosis Program
2 Clinical Epidemiology Unit
3 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
4 Department of Medicine
5 DRA - Department of Medicine - Halifax
6 PSW - Clinical Epidemiology Program
Abstract : BACKGROUND: Deep vein thrombosis (DVT) can be safely and reliably excluded in patients with a low clinical probability and a negative D-dimer result but the accuracy and utility of such a strategy is unclear in elderly patients. OBJECTIVES: We sought to compare the performance of the Wells pretest probability (PTP) model and D-dimer testing between patients of different age groups and to examine the utility of the two PTP model classification schemes (low/moderate/high vs. unlikely/likely) in excluding DVT in elderly outpatients. PATIENTS/METHODS: Pooled analysis of databases from three prospective diagnostic studies evaluating consecutive outpatients with suspected DVT. RESULTS: A total of 2696 patients were evaluated. DVT was diagnosed in 400 (15%) patients overall and in 50 out of 325 (15.5%) patients > or = 60 years old. The PTP distribution and the prevalence of DVT in each PTP category were similar among the different age groups. The negative predictive values of a low or unlikely PTP score in combination with a negative D-dimer result were 99% for all groups. A negative D-dimer in combination with a low or unlikely PTP excluded 21.7% and 31% of patients > or = 80 years old, respectively. CONCLUSIONS: The combination of a low or unlikely PTP with a negative D-dimer result can effectively and safely exclude DVT in a significant proportion of elderly outpatients. However, this clinical prediction rule needs to be prospectively validated with different D-dimer assays in this specific population.
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Article dans une revue
Journal of Thrombosis and Haemostasis, Wiley, 2008, 6 (7), pp.1072-6. 〈10.1111/j.1538-7836.2008.03007.x〉
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http://hal.univ-brest.fr/hal-00685485
Contributeur : Ghislaine Calvez <>
Soumis le : jeudi 5 avril 2012 - 11:24:10
Dernière modification le : mercredi 10 janvier 2018 - 14:42:02

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Marc Carrier, Grégoire Le Gal, S. M. Bates, D. R. Anderson, P. S. Wells. D-dimer testing is useful to exclude deep vein thrombosis in elderly outpatients.. Journal of Thrombosis and Haemostasis, Wiley, 2008, 6 (7), pp.1072-6. 〈10.1111/j.1538-7836.2008.03007.x〉. 〈hal-00685485〉

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