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Value of D-Dimer Testing for the Exclusion of Pulmonary Embolism in Patients With Previous Venous Thromboembolism
Grégoire Le Gal, MD;
Marc Righini, MD;
Pierre-Marie Roy, MD;
Oliver Sanchez, MD;
Drahomir Aujesky, MD, MSc;
Arnaud Perrier, MD;
Henri Bounameaux, MD
Arch Intern Med. 2006;166:176-180.
Background D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence.
Methods We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up.
Results The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery.
Conclusions In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.
Author Affiliations: Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France (Dr Le Gal); Division of Angiology and Hemostasis (Drs Righini and Bounameaux) and Division of General Internal Medicine, Department of Internal Medicine (Dr Perrier), Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; Emergency Department, Angers University Hospital, Angers, France (Dr Roy); Pneumology Service, Hôpital Européen Georges Pompidou, Paris, France (Dr Sanchez); and Department of Medicine, University Hospital, Lausanne, Switzerland (Dr Aujesky).
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