Does an immunochromatographic D-dimer exclude acute lower limb deep venous thrombosis?

Journal Article (Journal Article)

BACKGROUND: A pre-test probability score and D-dimer may reduce the need for ultrasound examinations for excluding lower limb deep venous thrombosis (DVT). OBJECTIVE: To establish the accuracy of an immunochromatographic D-dimer assay called 'Simplify' for diagnosis of acute DVT by complete (calf veins included) lower limb ultrasound examination. METHODS: A total of 453 consecutive patients presented to the ED of a tertiary centre with suspected first episode of DVT, were prospectively recruited. A pre-test probability score (Hamilton Score), an immunochromatographic D-dimer and a complete, single, unilateral lower limb ultrasound examination were performed in all patients. All patients with a negative ultrasound examination were followed up for 3 months. RESULTS: There were 159 men and 294 women with a mean age of 55.8 years (SD 20.3). Of the 227 patients with a negative D-dimer, 214 patients had negative ultrasound examinations and 13 patients had isolated calf DVT. Among the 226 patients with a positive D-dimer, 74 patients had DVT and 152 patients had negative ultrasound examinations. The sensitivity, specificity, positive and negative predictive values were 85.1% (75.8-91.8), 58.5% (53.4-63.5), 32.7% (26.6-38.9) and 94.3% (90.4-96.9), respectively. One hundred and sixty-five patients had an unlikely Hamilton Score and a negative D-dimer. The negative predictive value of the immunochromatographic D-dimer in an unlikely Hamilton Score population was 98.8% (95.7-99.8%). CONCLUSION: An unlikely probability Hamilton Score and a negative immunochromatographic D-dimer reliably exclude both proximal and isolated calf DVT.

Full Text

Duke Authors

Cited Authors

  • Subramaniam, RM; Heath, R; Cox, K; Chou, T; Stewart, J; Sleigh, J

Published Date

  • October 2006

Published In

Volume / Issue

  • 18 / 5-6

Start / End Page

  • 457 - 463

PubMed ID

  • 17083634

International Standard Serial Number (ISSN)

  • 1742-6731

Digital Object Identifier (DOI)

  • 10.1111/j.1742-6723.2006.00866.x

Language

  • eng

Conference Location

  • Australia