Published 19 August 2009, doi:10.1136/bmj.b2799
Cite this as: BMJ 2009;339:b2799

Editorials

Diagnosis of venous thromboembolism

D-dimer tests can help management but cannot replace clinical judgment

The first 150 words of the full text of this article appear below.

Because the signs and symptoms of deep venous thrombosis and pulmonary embolism are common but non-specific, they often present a diagnostic challenge. Both underdiagnosis and overdiagnosis are associated with substantial morbidity and mortality.

D-dimers are fibrin degradation products resulting from endogenous fibrinolysis associated with intravascular thrombosis. A non-specific increase in D-dimer concentration is seen in many situations, precluding its use for diagnosing venous thromboembolism (VTE). However, a low D-dimer concentration is thought to rule out the presence of circulating fibrin and therefore VTE. Early enzyme linked immunosorbent assay D-dimer tests took a long time to do, limiting their usefulness in acute care. Second generation assays provide results within an hour, and point of care tests produce results within 10-15 minutes.

In the linked systematic review and meta-analysis (doi:10.1136/bmj.b2990), Geersing and colleagues analysed the diagnostic performances of several qualitative and quantitative D-dimer tests used at the point of care.¹ . . . [Full text of this article]

¹ Service des Urgences, Centre Hospitalier Universitaire, F-49933 Angers Cedex 9, France

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis

G J Geersing, K J M Janssen, R Oudega, L Bax, A W Hoes, J B Reitsma, and K G M Moons
BMJ 2009 339: b2990. [Abstract] [Full Text] [PDF]

Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism

Pierre-Marie Roy, Isabelle Colombet, Pierre Durieux, Gilles Chatellier, Hervé Sors, and Guy Meyer
BMJ 2005 331: 259. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• (2009). Ruling Out VTE with Point-of-Care D-Dimer Testing. JWatch Emergency Med. 2009: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Venous thromboembolism despite normal D-dimers

Jecko Thachil
bmj.com, 21 Aug 2009 [Full text]

Running up Snowdon with venous thromboemboli

Mark D Coley
bmj.com, 30 Aug 2009 [Full text]

Online poll

Find out more here>> and here>>