en
Scientific article
Meta-analysis
English

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

Published inThrombosis and haemostasis, vol. 101, no. 5, p. 886-892
Publication date2009
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
  • Aged
  • Aged, 80 and over
  • Anticoagulants/therapeutic use
  • Biological Markers/blood
  • Diagnosis, Differential
  • Female
  • Fibrin Fibrinogen Degradation Products/*analysis
  • Gestalt Theory
  • *Health Status Indicators
  • Humans
  • Male
  • Predictive Value of Tests
  • Pulmonary Embolism/*blood/*diagnosis/drug therapy/etiology
  • Risk Assessment
  • Risk Factors
  • Sensitivity and Specificity
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
Identifiers
ISSN of the journal0340-6245
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Creation04/23/2012 10:26:42 AM
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