Journal
THROMBOSIS AND HAEMOSTASIS
Volume 101, Issue 5, Pages 886-892Publisher
GEORG THIEME VERLAG KG
DOI: 10.1160/TH-08-10-0689
Keywords
D-dimer; diagnosis; management study; predictive value of tests; venous thromboembolism
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Clinical outcome studies have shown that it is safe to withhold anticoagulant therapy in patients with suspected pulmonary embolism (PE) who have a negative D-dimer result and a low pretest probability (PTP) either using a PTP model or clinical gestalt. It was the objective of the present study to assess the safety of the combination of a negativeVIIDAS (c) D-dimer result in combination with a non-high PTP using the Wells or Geneva models to exclude PEA systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Seven studies (6 prospective management studies and I randomised controlled trial) reporting failure rates at three months were included in the analysis. Non-high PTP was defined as unlikely using the Wells' model, or low/intermediate PTP using either the Geneva score, the Revised Geneva Score, or clinical gestalt. Two reviewers independently extracted data onto standardised forms. A total of 5,622 patients with low/intermediate or unlikely PTP were assessed using the VIDAS D-dimer. PE was ruled out by a negative D-dimer test in 2,248 (40%, 95% confidence intervals [CI] 38.7 to 41.3%) of them. The three-month thromboembolic risk in patients left untreated on the basis of a low/intermediate or unlikely PTP and a negative D-dimer test was 3/2,166 (0.14%, 95% Cl 0.05 to 0.41%). In conclusion, the combination of a negative VIDAS D-dimer result and a non-high PTP effectively and safely excludes PE in an important proportion of outpatients with suspected PE.
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