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Am J Med. 2003 Mar;114(4):276-82.

Limitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism.

Author information

1
Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. brotmad@ccf.org

Abstract

PURPOSE:

To determine the utility and limitations of D-dimer testing for the evaluation of venous thromboembolism in hospitalized patients.

METHODS:

We performed D-dimer testing by four different methods in unselected inpatients undergoing radiologic evaluation for possible venous thromboembolism. We included patients with a history of malignancy, recent surgery, thrombosis, and anticoagulation treatment. C-reactive protein levels were assayed as a measure of inflammation.

RESULTS:

Of 45 patients with radiographically proven proximal deep venous thrombosis or pulmonary embolism, 43 had elevated D-dimer levels by enzyme-linked immunosorbent assay (ELISA) (sensitivity, 96%); the specificity of the test was 23% (36/157). The qualitative non-ELISA tests had higher specificities, but their sensitivities were <70%. Nineteen patients (42%) with thrombosis had false-negative D-dimer tests by at least one assay. The specificity of the tests decreased with increasing duration of hospitalization, increasing age, and increasing C-reactive protein levels. D-dimer testing had little or no utility in distinguishing patients with thrombosis from those without in patients who had been hospitalized for more than 3 days, were older than 60 years, or had C-reactive protein levels in the highest quartile.

CONCLUSION:

In unselected inpatients, D-dimer testing has limited clinical utility because of its poor specificity. This is particularly true for older patients, those who have undergone prolonged hospitalization, and those with markedly elevated C-reactive protein levels. In some patient subsets, a negative non-ELISA D-dimer test cannot discriminate between inpatients with and without thrombosis.

PMID:
12681454
DOI:
10.1016/s0002-9343(02)01520-6
[Indexed for MEDLINE]

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