UNIGE document Scientific Article - Meta-analysis
previous document  unige:19512  next document
add to browser collection
Title

VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies

Authors
Carrier, Marc
Djurabi, Reza Karami
Huisman, Menno V.
Wells, Philip S.
Rodger, Marc
Wuillemin, Walter A.
show hidden authors show all authors [1 - 9]
Published in Thrombosis and Haemostasis. 2009, vol. 101, no. 5, p. 886-892
Abstract 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 negative VIDAS D-dimer result in combination with a non-high PTP using the Wells or Geneva models to exclude PE. A 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 1 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% CI 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.
Keywords AgedAged, 80 and overAnticoagulants/therapeutic useBiological Markers/bloodDiagnosis, DifferentialFemaleFibrin Fibrinogen Degradation Products/*analysisGestalt Theory*Health Status IndicatorsHumansMalePredictive Value of TestsPulmonary Embolism/*blood/*diagnosis/drug therapy/etiologyRisk AssessmentRisk FactorsSensitivity and Specificity
Identifiers
PMID: 19404542
Full text
This document has no fulltext available yet, but you can contact its author by using the form below.
Structures
Research groups Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) (585)
La maladie thromboembolique veineuse (808)
Citation
(ISO format)
CARRIER, Marc et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies. In: Thrombosis and Haemostasis, 2009, vol. 101, n° 5, p. 886-892. doi: 10.1160/th-08-10-0689 https://archive-ouverte.unige.ch/unige:19512

436 hits

0 download

Update

Deposited on : 2012-04-23

Export document
Format :
Citation style :