D-dimer: Difference between revisions
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In [[medicine]], '''D-dimer''' is a [[fibrin degradation product]] after [[coagulation]]. | In [[medicine]], '''D-dimer''' is a [[fibrin degradation product]] after [[coagulation]]. It may be elevated in patients with [[pulmonary embolism]] or [[deep venous thrombosis]]. | ||
[[Immunologic test]]s for d-dimer are generally use [[immunoassay]]s such as [[enzyme-linked immunosorbent assay]] or [[serologic test]]s such as [[agglutination test]]s. The [[immunoassay]]s (more specifically, [[enzyme-linked immunosorbent assay]]) tend to be more [[sensitivity and specificity|sensitive]].<ref name="pmid15096330">{{cite journal |author=Stein PD, Hull RD, Patel KC, ''et al.'' |title=D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=589–602 |year=2004 |month=April |pmid=15096330 |doi= |url=http://www.annals.org/cgi/content/full/140/8/589 |issn=}}</ref> | [[Immunologic test]]s for d-dimer are generally use [[immunoassay]]s such as [[enzyme-linked immunosorbent assay]] or [[serologic test]]s such as [[agglutination test]]s. The [[immunoassay]]s (more specifically, [[enzyme-linked immunosorbent assay]]) tend to be more [[sensitivity and specificity|sensitive]].<ref name="pmid15096330">{{cite journal |author=Stein PD, Hull RD, Patel KC, ''et al.'' |title=D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=589–602 |year=2004 |month=April |pmid=15096330 |doi= |url=http://www.annals.org/cgi/content/full/140/8/589 |issn=}}</ref> | ||
In interpretation of the d-dimer, for patients over age 50 a value of ageX10 may be abnormal.<ref name="pmid20354012">{{cite journal| author=Douma RA, le Gal G, Söhne M, Righini M, Kamphuisen PW, Perrier A et al.| title=Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. | journal=BMJ | year= 2010 | volume= 340 | issue= | pages= c1475 | pmid=20354012 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20354012 | doi=10.1136/bmj.c1475 }} </ref> | |||
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| Whole blood [[hemagglutination test]] such as SimpliRED™|| 78%<ref name="pmid15096330"/><br>87%<ref name="pmid17155963"/>|| 74%<ref name="pmid15096330"/><br>66%<ref name="pmid17155963"/> | | Whole blood [[hemagglutination test]] such as SimpliRED™|| 78%<ref name="pmid15096330"/><br>87%<ref name="pmid17155963"/>|| 74%<ref name="pmid15096330"/><br>66%<ref name="pmid17155963"/> | ||
|} | |} | ||
==Using D-dimer to determine duration of anticoagulation treatment== | ==Using D-dimer to determine duration of anticoagulation treatment== | ||
Revision as of 09:38, 1 April 2010
In medicine, D-dimer is a fibrin degradation product after coagulation. It may be elevated in patients with pulmonary embolism or deep venous thrombosis.
Immunologic tests for d-dimer are generally use immunoassays such as enzyme-linked immunosorbent assay or serologic tests such as agglutination tests. The immunoassays (more specifically, enzyme-linked immunosorbent assay) tend to be more sensitive.[1]
In interpretation of the d-dimer, for patients over age 50 a value of ageX10 may be abnormal.[2]
| sensitivity | specificity | |
|---|---|---|
| Immunoassays | ||
| Elisa such as VIDAS™ | 95%[1] 96%[3] |
44%[1] 39%[3] |
| Agglutination tests | ||
| Latex agglutination such as Tinaquant™ | 89%[1] 96%[3] |
45%[1] 43%[3] |
| Whole blood hemagglutination test such as SimpliRED™ | 78%[1] 87%[3] |
74%[1] 66%[3] |
Using D-dimer to determine duration of anticoagulation treatment
An abnormal D-dimer level at the end of treatment might signal the need for continued anticoagulation with warfarin among patients with embolism and thrombosis such as a first unprovoked pulmonary embolism. If the D-dimer is abnormal, anticoaguation should be continued, if the D-dimer is normal, the duration of treatment is uncertain.[4] In an observation study that collected the D-dimer before stopping anticoagulation, the D-dimer was not as predictive.[5]
Screening for deep venous thrombosis
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Stein PD, Hull RD, Patel KC, et al. (April 2004). "D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review". Ann. Intern. Med. 140 (8): 589–602. PMID 15096330. [e]
- ↑ Douma RA, le Gal G, Söhne M, Righini M, Kamphuisen PW, Perrier A et al. (2010). "Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts.". BMJ 340: c1475. DOI:10.1136/bmj.c1475. PMID 20354012. Research Blogging.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Di Nisio M, Squizzato A, Rutjes AW, Büller HR, Zwinderman AH, Bossuyt PM (February 2007). "Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review". J. Thromb. Haemost. 5 (2): 296–304. DOI:10.1111/j.1538-7836.2007.02328.x. PMID 17155963. Research Blogging.
- ↑ Palareti G, Cosmi B, Legnani C, et al (2006). "D-dimer testing to determine the duration of anticoagulation therapy". N. Engl. J. Med. 355 (17): 1780-9. DOI:10.1056/NEJMoa054444. PMID 17065639. Research Blogging.
- ↑ Rodger MA, Kahn SR, Wells PS, Anderson DA, Chagnon I, Le Gal G, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ. 2008 Aug 26;179(5):417-426.