<scp>d</scp>-Dimer and Venous Thromboembolism
Authors: John T. Philbrick, Steven Heim, Joel M. Schectman
Journal: Annals of Internal Medicine (2004)

Letters21 September 2004d-Dimer and Venous ThromboembolismJohn T. Philbrick, MD, Steven Heim, MD, MSPH, and Joel M. Schectman, MD, MPHJohn T. Philbrick, MDFrom University of Virginia, Charlottesville, VA 22908.Search for more papers by this author, Steven Heim, MD, MSPHFrom University of Virginia, Charlottesville, VA 22908.Search for more papers by this author, and Joel M. Schectman, MD, MPHFrom University of Virginia, Charlottesville, VA 22908.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Although Stein and colleagues' conclusion, “a negative quantitative rapid ELISA result is as diagnostically useful as a normal lung scan or negative duplex ultrasonography finding,” is technically correct (1), the issues surrounding this use of d-dimer are more complex. For a test used to rule out disease, high sensitivity is not the only important characteristic. Specificity also plays a key role and limits the use of d-dimer for venous thromboembolism (VTE) in at least 2 ways.First, the likelihood ratio for a negative test result, calculated as (1 − sensitivity)/specificity, is inversely proportional to specificity. Few tests ...References1. Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al . d-Dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140:589-602. [PMID: 15096330] LinkGoogle Scholar2. Brotman DJ, Segal JB, Jani JT, Petty BG, Kickler TS. Limitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism. Am J Med. 2003;114:276-82. [PMID: 12681454] CrossrefMedlineGoogle Scholar3. Goldstein NM, Kollef MH, Ward S, Gage BF. The impact of the introduction of a rapid D-dimer assay on the diagnostic evaluation of suspected pulmonary embolism. Arch Intern Med. 2001;161:567-71. [PMID: 11252116] CrossrefMedlineGoogle Scholar4. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al . Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227-35. [PMID: 14507948] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Virginia, Charlottesville, VA 22908. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee Alsod-Dimer for the Exclusion of Acute Venous Thrombosis and Pulmonary Embolism Paul D. Stein , Russell D. Hull , Kalpesh C. Patel , Ronald E. Olson , William A. Ghali , Rollin Brant , Rita K. Biel , Vinay Bharadia , and Neeraj K. Kalra d-Dimer and Venous Thromboembolism Fabio Puglisi and Edda Federico d-Dimer and Venous Thromboembolism Russell D. Hull , William A. Ghali , Rollin F. Brant , and Paul D. Stein d-Dimer and Venous Thromboembolism Stephen J. Wolf d-Dimer and Venous Thromboembolism Grégoire Le Gal , Marc Righini , and Henri Bounameaux Metrics Cited ByAppropriate Use of Venous Imaging and Analysis of the D-Dimer/Clinical Probability Testing Paradigm in the Diagnosis and Location of Deep Venous ThrombosisAppropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital 21 September 2004Volume 141, Issue 6Page: 482KeywordsD-dimerEnzyme linked immunosorbent assayLikelihood ratioLungsPatientsSpecificityThromboembolismTrauma surgeryUltrasound imagingVenous thromboembolism ePublished: 21 September 2004 Issue Published: 21 September 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...