Pretest probability assessment combined with point-of-care D-dimer testing allows primary care physicians to rule out pulmonary embolism

2013 ◽  
Vol 18 (5) ◽  
pp. 187-188
Author(s):  
Christopher Kabrhel
Keyword(s):  
Primary Care ◽  
Pulmonary Embolism ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Pretest Probability ◽  
Probability Assessment ◽  
D Dimer ◽  
Rule Out

Pulmonary Embolism

2019 ◽  
Author(s):  
Nadav Granat ◽  
Evan Avraham Alpert
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Blood Clot ◽  
Pretest Probability ◽  
Treatment Modalities ◽  
Pulmonary Vasculature ◽  
Pulmonary Angiogram ◽  
Catheter Directed Thrombolysis ◽  
D Dimer ◽  
Rule Out

Pulmonary embolism is caused by a blood clot that travels from the deep veins through the heart and then lodges in the pulmonary vasculature. Common symptoms include pleuritic chest pain, dyspnea, or palpitations. Clinical scores such as the Wells score and Revised Geneva score can be used to assess the pretest probability of pulmonary embolism (PE) and guide work-up such as deciding to order D-dimer testing or imaging. However, clinical gestalt can also accurately assess the pretest probability of PE. The Pulmonary Embolism Rule-out Criteria is a decision rule that can be used to rule out PE without further testing. Imaging modalities include computed tomography pulmonary angiogram or ventilation/perfusion scanning. Novel or new oral anticoagulants are becoming the mainstay of treatment for the hemodynamically stable patient with pulmonary embolism. For the patient who is hemodynamically unstable, treatment modalities include intravenous alteplase, catheter-directed thrombolysis, surgical embolectomy, and catheter-directed embolectomy. A subset of patients with PE can be treated as outpatients. This review contains 1 figure, 4 tables, and 55 references. Key Words: anticoagulants, antithrombins, D-dimer, low-molecular-weight heparin, mechanical thrombolysis, multidetector computed tomography, radionuclide imaging, unfractionated heparin, pulmonary embolism, tissue plasminogen activator, warfarin

The cost–effectiveness of point-of-care D-dimer tests compared with a laboratory test to rule out deep venous thrombosis in primary care

2014 ◽  
Vol 15 (1) ◽  
pp. 125-136 ◽  
Author(s):  
Janneke MT Hendriksen ◽  
Geert-Jan Geersing ◽  
Suzanne C van Voorthuizen ◽  
Ruud Oudega ◽  
Arina J ten Cate-Hoek ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Laboratory Test ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Point Of Care ◽  
The Cost ◽  
D Dimer ◽  
Rule Out

scholarly journals Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis

2010 ◽  
Vol 11 (1) ◽  
Author(s):  
Wim AM Lucassen ◽  
Renée A Douma ◽  
Diane B Toll ◽  
Harry R Büller ◽  
Henk CPM van Weert
Keyword(s):  
Primary Care ◽  
Pulmonary Embolism ◽  
Scenario Analysis ◽  
Point Of Care ◽  
Wells Rule ◽  
D Dimer

scholarly journals Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care

2015 ◽  
Vol 13 (6) ◽  
pp. 1004-1009 ◽  
Author(s):  
W. A. M. Lucassen ◽  
P. M. G. Erkens ◽  
G. J. Geersing ◽  
H. R. Büller ◽  
K. G. M. Moons ◽  
...  
Keyword(s):  
Primary Care ◽  
Pulmonary Embolism ◽  
Point Of Care ◽  
D Dimer

D-Dimer and CT Rule Out Pulmonary Embolism

2008 ◽  
Vol 1 (2) ◽  
pp. 11
Author(s):  
DAMIAN MCNAMARA
Keyword(s):  
Pulmonary Embolism ◽  
D Dimer ◽  
Rule Out

D-Dimer Determination to Exclude Pulmonary Embolism: a Two-Step Approach Using Latex Assay as a Screening Tool

1994 ◽  
Vol 72 (01) ◽  
pp. 089-091 ◽  
Author(s):  
P de Moerloose ◽  
Ph Minazio ◽  
G Reber ◽  
A Perrier ◽  
H Bounameaux
Keyword(s):  
Pulmonary Embolism ◽  
Screening Tool ◽  
Screening Tests ◽  
Enzyme Linked Immunosorbent Assay ◽  
Elisa Assay ◽  
Elisa Technique ◽  
Diagnostic Step ◽  
D Dimer ◽  
Rule Out ◽  
Latex Test

SummaryD-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests. We tested this hypothesis by comparing DD levels measured by ELISA and latex assays in 334 patients suspected of pulmonary embolism. All but one patient with a positive (DD ≥500 ng/ml) latex assay had DD levels higher than 500 ng/ml with the ELISA assay. Accordingly, ELISA technique could be restricted to patients with a negative result in latex assay. This two-step approach would have spared about 50% of ELISA in our cohort. In conclusion, our data indicate that a latex test can be used as a first diagnostic step to rule out pulmonary embolism provided a negative result is confirmed by ELISA and the performance of the latex assay used has been assessed properly.

Evidence for Age-Adjusted D-Dimer to Rule out Pulmonary Embolism: An Institutional Study

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S5-S5
Author(s):  
Ridin Balakrishnan ◽  
Daniel Casa ◽  
Morayma Reyes Gil
Keyword(s):  
Pulmonary Embolism ◽  
False Positive ◽  
False Positive Rate ◽  
Moderate Risk ◽  
Older Population ◽  
Statistical Measures ◽  
Positive Rate ◽  
Risk Patients ◽  
D Dimer ◽  
Rule Out

Abstract The diagnostic approach for ruling out suspected acute pulmonary embolism (PE) in the ED setting includes several tests: ultrasound, plasma d-dimer assays, ventilation-perfusion scans and computed tomography pulmonary angiography (CTPA). Importantly, a pretest probability scoring algorithm is highly recommended to triage high risk cases while also preventing unnecessary testing and harm to low/moderate risk patients. The d-dimer assay (both ELISA and immunoturbidometric) has been shown to be extremely sensitive to rule out PE in conjunction with clinical probability. In particularly, d-dimer testing is recommended for low/moderate risk patients, in whom a negative d-dimer essentially rules out PE sparing these patients from CTPA radiation exposure, longer hospital stay and anticoagulation. However, an unspecific increase in fibrin-degradation related products has been seen with increase in age, resulting in higher false positive rate in the older population. This study analyzed patient visits to the ED of a large academic institution for five years and looked at the relationship between d-dimer values, age and CTPA results to better understand the value of age-adjusted d-dimer cut-offs in ruling out PE in the older population. A total of 7660 ED visits had a CTPA done to rule out PE; out of which 1875 cases had a d-dimer done in conjunction with the CT and 5875 had only CTPA done. Out of the 1875 cases, 1591 had positive d-dimer results (>0.50 µg/ml (FEU)), of which 910 (57%) were from patients older than or equal to fifty years of age. In these older patients, 779 (86%) had a negative CT result. The following were the statistical measures of the d-dimer test before adjusting for age: sensitivity (98%), specificity (12%); negative predictive value (98%) and false positive rate (88%). After adjusting for age in people older than 50 years (d-dimer cut off = age/100), 138 patients eventually turned out to be d-dimer negative and every case but four had a CT result that was also negative for a PE. The four cases included two non-diagnostic results and two with subacute/chronic/subsegmental PE on imaging. None of these four patients were prescribed anticoagulation. The statistical measures of the d-dimer test after adjusting for age showed: sensitivity (96%), specificity (20%); negative predictive value (98%) and a decrease in the false positive rate (80%). Therefore, imaging could have been potentially avoided in 138/779 (18%) of the patients who were part of this older population and had eventual negative or not clinically significant findings on CTPA if age-adjusted d-dimers were used. This data very strongly advocates for the clinical usefulness of an age-adjusted cut-off of d-dimer to rule out PE.

scholarly journals »Point-of-Care« D-Dimer Testing

2010 ◽  
Vol 29 (4) ◽  
pp. 282-287 ◽  
Author(s):  
Jovan Antović
Keyword(s):  
Primary Care ◽  
Venous Thromboembolism ◽  
Emergency Departments ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Turnaround Time ◽  
The Other ◽  
Clinical Conditions ◽  
D Dimer ◽  
Laboratory Assay

»Point-of-Care« D-Dimer TestingD-dimer testing is efficient in the exclusion of venous thromboembolism (VTE). D-dimer laboratory assays are predominantly performed in centralised laboratories in intra-hospital settings although most patients with suspected VTE are presented in primary care. On the other hand decreasing turnaround time for laboratory testing may significantly improve efficacy in emergency departments. Therefore an introduction of a rapid, easy to perform point of care (POC) assay for the identification of D-dimer may offer improvement in diagnostics flow of VTE both in primary care and emergency departments while it could also improve our diagnostic possibilities in some other severe clinical conditions (e.g. disseminated intra-vascular coagulation (DIC) and aortic aneurism (AA)) associated with increased D-dimer. Several POC D-dimer assays have been evaluated and majority of them have met the criteria for rapid and safe exclusion of VTE. In our hands three assays (Stratus, Pathfast and Cardiac) have the laboratory performance profile comparable with our routine D-dimer laboratory assay (Tinaqaunt).

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