Download PDF
Semin Vasc Med 2001; 01(2): 175-180
DOI: 10.1055/s-2001-18485
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Fibrin D-Dimer Measurement in Suspected Pulmonary Embolism

Philippe de Moerloose1 , Martin H. Prins2
  • 1Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospital of Geneva, Switzerland
  • 2Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital Maastricht, University of Maastricht, The Netherlands
Further Information

Publication History

Publication Date:
16 November 2001 (online)

    Permissions and Reprints

ABSTRACT

Due to increased awareness among physicians, the prevalence of pulmonary embolism (PE) in patients clinically suspected of the disease has steadily decreased during the past 15 years. This has led to the development of simple diagnostic tools in an attempt to reduce the number of invasive or costly exams needed to manage these patients. D-dimer (DD) measurement has proven to be a simple and very useful test to exclude PE and several strategies combining DD with clinical probability and other exams have been validated in large outcome studies. The problem faced by many physicians is the choice of the specific DD test and its more appropriate position in the diagnostic work-up of patients suspected of PE. This article focuses on these questions and also provides some limitations of DD use, such as its poor specificity in hospitalized and elderly patients.

KEYWORD

D-dimer - pulmonary embolism - elderly - diagnostic strategies

REFERENCES

  • 1 Bounameaux H, de Moerloose P, Perrier A, Miron M-J. D-dimer testing in suspected venous thromboembolism: an update.  Q J Med . 1997;  90 437-442
    CrossrefPubMedGoogle Scholar
  • 2 de Moerloose P, Michiels J J, Bounameaux H. The place of D-dimer testing in an integrated approach of patients suspected of pulmonary embolism.  Semin Thromb Haemos . 1998;  24 409-412
    PubMedGoogle Scholar
  • 3 The PIOPED Investigators. Value of ventilation-perfusion scan in acute pulmonary embolism.  JAMA . 1990;  263 2753-2759
    Google Scholar
  • 4 Perrier A, Bounameaux H. Diagnosis of pulmonary embolism in outpatients by sequential noninvasive tools.  Semin Thromb Hemost . 2001;  27 25-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Hull R D, Raskob G E, Ginsberg J S. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism.  Arch Intern Med . 1994;  154 289-297
    CrossrefPubMedGoogle Scholar
  • 6 Perrier A, Bounameaux H, Morabia A. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer and ultrasonography: a management study.  Arch Intern Med . 1996;  156 531-536
    CrossrefPubMedGoogle Scholar
  • 7 Wells P S, Ginsberg J S, Anderson D R. Use of a clinical model for safe management of patients with suspected pulmonary embolism.  Ann Intern Med . 1998;  129 997-1005
    Google Scholar
  • 8 Perrier A, Desmarais S, Miron M J. Noninvasive diagnosis of pulmonary venous thromboembolism in outpatients.  Lancet . 1999;  353 190-195
    Google Scholar
  • 9 de Groot R M, van Marwijk M, Pouwels J G, Engelage A H, Kuipers B F, Büller H R. The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study.  Thromb Haemost . 1999;  82 1588-1592
    PubMedGoogle Scholar
  • 10 van der Graaf F, van der Borne H, van der Kolk M, de Wild J P, Janssen G WT, van Uum H M S. Exclusion of deep vein thrombosis with D-dimer testing. Comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard.  Thromb Haemost . 2000;  83 191-198
    PubMedGoogle Scholar
  • 11 Janssen M CH, Heebels A E, de Metz M. Reliability of five rapid D-dimer assays compared to ELISA in the exclusion of deep venous thrombosis.  Thromb Haemost . 1997;  77 262-266
    PubMedGoogle Scholar
  • 12 Freyburger G, Trillaud H, Labrouche S. D-dimer strategy in thrombosis exclusion. A gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism: 8 DD methods compared.  Thromb Haemost . 1998;  79 32-37
    PubMedGoogle Scholar
  • 13 de Moerloose P. D-dimer assays for the exclusion of venous thromboembolism: which test for which diagnostic strategy?.  Thromb Haemost . 2000;  83 180-181
    PubMedGoogle Scholar
  • 14 Mauron T, Baumgartner I, Z'Brun A. SimpliRED D-dimer assay: comparability of capillary and citrated venous whole blood, between-assay variability, and performance of the test for exclusion of deep vein thrombosis in symptomatic outpatients.  Thromb Haemost . 1998;  79 1217-1219
    PubMedGoogle Scholar
  • 15 Reber G, de Moerloose P. D-dimer assays for the exclusion of venous thromboembolism.  Semin Thromb Haemos . 2000;  26 619-624
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 de Moerloose P, Minazio P, Reber G, Perrier A, Bounameaux H. D-dimer determination to exclude pulmonary embolism: a two-step approach using latex assays as a screening tool.  Thromb Haemost . 1994;  72 89-91
    PubMedGoogle Scholar
  • 17 Perrier A, Buswell L, Bounameaux H. Cost-effectiveness of noninvasive diagnostic aids in suspected pulmonary embolism.  Arch Intern Med . 1997;  157 2309-2316
    Google Scholar
  • 18 Raimondi P, Bongard O, de Moerloose P, Reber G, Waldvogel F, Bounameaux H. D-dimer plasma concentration in various clinical conditions: implication for the use of this test in the diagnostic approach of venous thromboembolism.  Thromb Res . 1993;  69 125-130
    CrossrefPubMedGoogle Scholar
  • 19 Miron M-J, Perrier A, Bounameaux H. Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients.  Eur Resp J . 1999;  13 1365-1370
    CrossrefPubMedGoogle Scholar
  • 20 Freyburger G, Trillaud H, Labrouche S, Gauthier P, Javorshi S, Grenier N. Rapid D-dimer ELISA testing in the exclusion of venous thromboembolism in hospitalized patients.  Clin Appl Thromb Haemost . 2000;  6 77-81
    PubMedGoogle Scholar
  • 21 Tardy B, Tardy-Poncet B, Viallon A. Evaluation of D-dimer ELISA test in elderly patients with suspected pulmonary embolism.  Thromb Haemost . 1998;  79 38-41
    PubMedGoogle Scholar
  • 22 Masotti L, Ceccarelli E, Capelli E, Forconi S. Plasma D-dimer levels in elderly patients with suspected pulmonary embolism.  Thromb Res . 2000;  98 577-579
    CrossrefPubMedGoogle Scholar
  • 23 Righini M, Goehring C, Bounameaux H, Perrier A. Effects of age on the performances of common diagnostic tests for pulmonary embolism.  Am J Med . 2000;  109 357-361
    CrossrefPubMedGoogle Scholar
  • 24 Righini M, de Moerloose P, Reber G, Perrier A, Bounameaux H. Should the D-dimer cut-off value be increased in elderly patients suspected of pulmonary embolism?.  Thromb Haemost . 2001;  85 744-745
    PubMedGoogle Scholar
      >