Effectiveness of D-dimer As a Screening Test for Venous Thromboembolism: an Update

Overview

Journal N Am J Med Sci

Specialty General Medicine

Date 2014 Dec 10

PMID 25489560

Citations 66

Authors

Swaroopa Pulivarthi

Murali Krishna Gurram

Affiliations

Soon will be listed here.

Abstract

Venous thromboembolism (VTE) is the leading cause of morbidity and mortality among hospitalized patients. We searched the PubMed database and reviewed the articles published until June 2011. Articles related to the D-dimer and VTE were considered to write this paper. Many factors play a key role in changing the sensitivity and specificity of D-dimer testing, including the extent of thrombosis and fibrinolytic activity, duration of symptoms, anticoagulant therapy, comorbidity due to surgical or medical illnesses, inflammatory diseases, cancer, elderly age, pregnancy and the postpartum period, and previous VTE. Many previous studies have shown that the D-dimer test is highly sensitive (>95%) in acute deep venous thrombosis or pulmonary embolism, usually with a cut-off value of 500 μg FEU/l, which reasonably rules out acute VTE, particularly in patients with low clinical probability (LCP) or intermediate clinical probability. Patients with high D-dimer levels upon presentation may prompt a more intense diagnostic approach, irrespective of pretest probability. Studies performed after a negative D-dimer for 3 months proved the high negative predictive value (NPV) of D-dimer testing together with LCP in patients with suspected VTE. Among oncology patients, D-dimer testing has the highest sensitivity and NPV in excluding VTE. The new cutoff values of D-dimer testing were analyzed in a recent prospective study of pregnant women; they are 286 ng DDU/ml, 457 ng DDU/ml, and 644 ng DDU/ml for the first, second, and third trimesters, respectively.

Citing Articles

Analysis of risk factors and construction of prediction model for lower extremity deep vein thrombosis after liver transplantation.

Xiao Y, Guo R, Yang H, Geng X Eur J Med Res. 2025; 30(1):127.

PMID: 39994749 PMC: 11849384. DOI: 10.1186/s40001-025-02367-z.

Effect of parenteral L-carnitine in hospitalized patients with moderate to severe COVID-19: A randomized double-blind clinical trial.

Naeimzadeh F, Sadeghi A, Saghaleini S, Sarbakhsh P, Mahmoodpoor A, Gharekhani A Bioimpacts. 2025; 15:30261.

PMID: 39963575 PMC: 11830133. DOI: 10.34172/bi.2024.30261.

Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients.

Guo Y, Zhang D, Chen Y, Liu W, Gao N, Weng X Clin Appl Thromb Hemost. 2025; 31():10760296241311265.

PMID: 39784945 PMC: 11719442. DOI: 10.1177/10760296241311265.

The limited clinical utility of a routine creatine kinase (CK) on admission to a psychiatric inpatient unit.

Scott F, Butler M, Rogers J BMC Psychiatry. 2024; 24(1):908.

PMID: 39696215 PMC: 11654146. DOI: 10.1186/s12888-024-06386-8.

Association of COVID-19 with acute and post-acute risk of multiple different complications and mortality in patients infected with omicron variant stratified by initial disease severity: a cohort study in Hong Kong.

Wan E, Zhang R, Mathur S, Yan V, Lai F, Chui C BMC Med. 2024; 22(1):461.

PMID: 39402606 PMC: 11476291. DOI: 10.1186/s12916-024-03630-6.

References

Speiser W, Mallek R, Koppensteiner R, Stumpflen A, Kapiotis S, Minar E . D-dimer and TAT measurement in patients with deep venous thrombosis: utility in diagnosis and judgement of anticoagulant treatment effectiveness. Thromb Haemost. 1990; 64(2):196-201. View

Chan W, Chunilal S, Lee A, Crowther M, Rodger M, Ginsberg J . A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann Intern Med. 2007; 147(3):165-70. DOI: 10.7326/0003-4819-147-3-200708070-00005. View

King V, Vaze A, Moskowitz C, Smith L, Ginsberg M . D-dimer assay to exclude pulmonary embolism in high-risk oncologic population: correlation with CT pulmonary angiography in an urgent care setting. Radiology. 2008; 247(3):854-61. DOI: 10.1148/radiol.2473070939. View

Kline J, Courtney D, Than M, Hogg K, Miller C, Johnson C . Accuracy of very low pretest probability estimates for pulmonary embolism using the method of attribute matching compared with the Wells score. Acad Emerg Med. 2010; 17(2):133-41. DOI: 10.1111/j.1553-2712.2009.00648.x. View

Prandoni P, Noventa F, Ghirarduzzi A, Pengo V, Bernardi E, Pesavento R . The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 2007; 92(2):199-205. DOI: 10.3324/haematol.10516. View

Di Nisio M, Squizzato A, Rutjes A, Buller H, Zwinderman A, Bossuyt P . Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost. 2006; 5(2):296-304. DOI: 10.1111/j.1538-7836.2007.02328.x. View

Moerloose P, Palareti G, Aguilar C, Legnani C, Reber G, Peetz D . A multicenter evaluation of a new quantitative highly sensitive D-dimer assay for exclusion of venous thromboembolism. Thromb Haemost. 2008; 100(3):505-12. DOI: 10.1160/th08-04-0202. View

Bosson J, Barro C, Satger B, Carpentier P, Polack B, Pernod G . Quantitative high D-dimer value is predictive of pulmonary embolism occurrence independently of clinical score in a well-defined low risk factor population. J Thromb Haemost. 2005; 3(1):93-9. DOI: 10.1111/j.1538-7836.2004.01045.x. View

Siragusa S, Terulla V, Pirrelli S, Porta C, Falaschi F, Anastasio R . A rapid D-dimer assay in patients presenting at the emergency room with suspected acute venous thrombosis: accuracy and relation to clinical variables. Haematologica. 2001; 86(8):856-61. View

10.

Rathbun S, Whitsett T, Raskob G . Negative D-dimer result to exclude recurrent deep venous thrombosis: a management trial. Ann Intern Med. 2004; 141(11):839-45. PMC: 1382279. DOI: 10.7326/0003-4819-141-11-200412070-00007. View

11.

Ten Wolde M, Kraaijenhagen R, Prins M, Buller H . The clinical usefulness of D-dimer testing in cancer patients with suspected deep venous thrombosis. Arch Intern Med. 2002; 162(16):1880-4. DOI: 10.1001/archinte.162.16.1880. View

12.

Brown M, Rowe B, Reeves M, Bermingham J, Goldhaber S . The accuracy of the enzyme-linked immunosorbent assay D-dimer test in the diagnosis of pulmonary embolism: a meta-analysis. Ann Emerg Med. 2002; 40(2):133-44. DOI: 10.1067/mem.2002.124755. View

13.

Stein P, Hull R, Patel K, Olson R, Ghali W, Brant R . D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004; 140(8):589-602. DOI: 10.7326/0003-4819-140-8-200404200-00005. View

14.

Kline J, Williams G, Hernandez-Nino J . D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem. 2005; 51(5):825-9. DOI: 10.1373/clinchem.2004.044883. View

15.

Soderberg M, Brohult J, Jorfeldt L, Larfars G . The use of D-dimer testing and Wells score in patients with high probability for acute pulmonary embolism. J Eval Clin Pract. 2008; 15(1):129-33. DOI: 10.1111/j.1365-2753.2008.00967.x. View

16.

Le Gal G, Righini M, Roy P, Sanchez O, Aujesky D, Perrier A . Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med. 2006; 166(2):176-80. DOI: 10.1001/archinte.166.2.176. View

17.

Gibson N, Sohne M, Gerdes V, Nijkeuter M, Buller H . The importance of clinical probability assessment in interpreting a normal d-dimer in patients with suspected pulmonary embolism. Chest. 2008; 134(4):789-793. DOI: 10.1378/chest.08-0344. View

18.

Perrier A, Roy P, Sanchez O, Le Gal G, Meyer G, Gourdier A . Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005; 352(17):1760-8. DOI: 10.1056/NEJMoa042905. View

19.

Lee J, Zierler B . The current state of practice in the diagnosis of venous thromboembolism at an academic medical center. Vasc Endovascular Surg. 2010; 45(1):22-7. DOI: 10.1177/1538574410385873. View

20.

Wells P, Anderson D, Rodger M, Forgie M, Kearon C, Dreyer J . Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003; 349(13):1227-35. DOI: 10.1056/NEJMoa023153. View