d-Dimer Testing in Pregnancy: Clinically Useful, but at What Cost?
Authors: Wee-Shian Chan
Journal: Annals of Internal Medicine (2008)

Letters18 March 2008d-Dimer Testing in Pregnancy: Clinically Useful, but at What Cost?Wee-Shian Chan, MD, MSc and Jeffrey S. Ginsberg, MDWee-Shian Chan, MD, MScFrom Women's College Hospital, Toronto, Ontario M5S 1B2, Canada, and McMaster University Health Sciences Centre, Hamilton, Ontario L8S 4L8, Canada.Search for more papers by this author and Jeffrey S. Ginsberg, MDFrom Women's College Hospital, Toronto, Ontario M5S 1B2, Canada, and McMaster University Health Sciences Centre, Hamilton, Ontario L8S 4L8, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-6-200803180-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Lippi and Montagnana raise 2 important issues about our study of pregnant women with suspected DVT: The low specificity and positive predictive value of the d-dimer test (SimpliRED) and the relatively small number of patients with DVT (n = 13) in our cohort result in wide 95% CIs associated with the sensitivity and negative predictive value of the test.We agree that the positive predictive value is far too low to conclude that an abnormal test result is diagnostic of DVT. The purpose of our study was to show that this d-dimer assay is sensitive and therefore has ...References1. Rathbun SW, Whitsett TL, Raskob GE. Negative d-dimer result to exclude recurrent deep venous thrombosis: a management trial. Ann Intern Med. 2004;141:839-45. [PMID: 15583225] LinkGoogle Scholar2. Kraaijenhagen RA, Piovella F, Bernardi E, Verlato F, Beckers EA, Koopman MM, et al. Simplification of the diagnostic management of suspected deep vein thrombosis. Arch Intern Med. 2002;162:907-11. [PMID: 11966342] CrossrefMedlineGoogle Scholar3. Kearon C, Ginsberg JS, Douketis J, Crowther MA, Turpie AG, Bates SM, et al. A randomized trial of diagnostic strategies after normal proximal vein ultrasonography for suspected deep venous thrombosis: d-dimer testing compared with repeated ultrasonography. Ann Intern Med. 2005;142:490-6. [PMID: 15809460] LinkGoogle Scholar4. Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: report from the Maternal Mortality Collaborative. Obstet Gynecol. 1988;72:91-7. [PMID: 3380512] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Women's College Hospital, Toronto, Ontario M5S 1B2, Canada, and McMaster University Health Sciences Centre, Hamilton, Ontario L8S 4L8, Canada.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNegative d-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial Suman W. Rathbun , Thomas L. Whitsett , and Gary E. Raskob A Randomized Trial of Diagnostic Strategies after Normal Proximal Vein Ultrasonography for Suspected Deep Venous Thrombosis: d-Dimer Testing Compared with Repeated Ultrasonography Clive Kearon , Jeffrey S. Ginsberg , James Douketis , Mark A. Crowther , Alexander G. Turpie , Shannon M. Bates , Agnes Lee , Patrick Brill-Edwards , Terri Finch , and Michael Gent A Red Blood Cell Agglutination d-Dimer Test to Exclude Deep Venous Thrombosis in Pregnancy Wee-Shian Chan , Sanjeev Chunilal , Agnes Lee , Mark Crowther , Marc Rodger , and Jeffrey S. Ginsberg d-Dimer Testing in Pregnancy: Clinically Useful, but at What Cost? Giuseppe Lippi and Martina Montagnana Metrics 18 March 2008Volume 148, Issue 6Page: 484-485KeywordsFetusesPregnancyProspective studiesPulmonary embolismSpecificityUltrasound imagingVenous thromboembolism ePublished: 18 March 2008 Issue Published: 18 March 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...