Editorials

Diagnosis of venous thromboembolism

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b2799 (Published 19 August 2009) Cite this as: BMJ 2009;339:b2799
  1. Pierre-Marie Roy, professor
  1. 1Service des Urgences, Centre Hospitalier Universitaire, F-49933 Angers Cedex 9, France
  1. PMRoy{at}chu-angers.fr

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

    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 They found that quantitative tests perform better than qualitative ones, but …

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