D-dimer

To my way of thinking, if the D-dimer remains elevated it may be too soon to stop the coumadin. posted by james gaulte @ 4:30 AM

Archive 2009-01-01 james gaulte 2009

In the first two instances, one then proceeds to obtain a highly sensitive D-dimer test e.g.,enzyme-linked immunosorbent assay.

Archive 2009-01-01 james gaulte 2009

The importance of not allowing the D-dimer's negativity to exclude PE is emphasized in this 2008 article from Holland in the journal CHEST.The authors reported data that indicated that almost 10% (9.3%) of patients with a likely diagnosis (they used a version of the Wells criteria that had only two categories, "likely" or "unlikely") and a negative D-dimer had evidence of thrombotic disease in the subsequent 3 months.

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

The importance of not allowing the D-dimer's negativity to exclude PE is emphasized in this 2008 article from Holland in the journal CHEST.The authors reported data that indicated that almost 10% (9.3%) of patients with a likely diagnosis (they used a version of the Wells criteria that had only two categories, "likely" or "unlikely") and a negative D-dimer had evidence of thrombotic disease in the subsequent 3 months.

Archive 2009-01-01 james gaulte 2009

I think a better reason not to rely on the D-dimer a high probability case is , is concern that a potentially fatal condition may be missed because of one erroneous negative biological lab test considering all the many ways lab tests can get screwed up.

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

However, if there is a high pretest probability of PE then one should not order the D-dimer but proceed directly to a multidetector chest CT .

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

There are some data indicating that about 5% of such patients have false negative D-dimer tests.

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

In the first two instances, one then proceeds to obtain a highly sensitive D-dimer test e.g.,enzyme-linked immunosorbent assay.

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

I have written about the D-dimer and Pulmonary embolism prediction rules before in a discussion about an earlier larger study from Holland which is generally considered to validate the rule of thumb that says "low likelihood Wells score plus negative high sensitivity D-dimer test equals no PE."

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009

This is said to be the case because-according to the NEJM review- clinical data have indicated that in patients with a high pretest likelihood of PE the negative predictive value of the D-dimer is too low to be safely determinative.

Does the pretest probablity of a condition really determine which test you should do? james gaulte 2009