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D-dimer strategy in thrombosis exclusion--a gold standard study in 100 patients suspected of deep venous thrombosis
G Freyburger1, H Trillaud, S Labrouche
1Laboratoire d'Hématologie, Hôpital Pellegrin, Université Bxll, Bordeaux, France. freyburg@quarternet.fr
Insights
D-dimer (DD) tests effectively screen for deep venous thrombosis and pulmonary embolism. A combination of routine latex and VIDAS D-Dimer methods offers the most cost-efficient diagnostic strategy.
Area of Science:
- Clinical diagnostics
- Hematology
- Medical imaging
Background:
- D-dimer (DD) is a valuable biomarker for screening deep venous thrombosis (DVT) and pulmonary embolism (PE).
- Newer rapid diagnostic methods require validation against established techniques.
- Radiologic examinations remain the gold standard but are invasive and costly.
Purpose of the Study:
- To compare the diagnostic performance of various D-dimer assays.
- To evaluate the efficiency and cost-effectiveness of different D-dimer testing strategies.
- To identify optimal screening protocols for suspected DVT and PE.
Main Methods:
- Comparative performance evaluation of 3 ELISA, 5 rapid, and 2 routine latex D-dimer methods.
- Study included 100 patients with suspected deep venous thrombosis or pulmonary embolism.
- Cost-effectiveness analysis of different diagnostic strategies.
Main Results:
- One rapid quantitative D-dimer method demonstrated ELISA-comparable efficiency.
- The combination of a routine latex method with VIDAS D-Dimer bioMérieux proved most efficient.
- Performance varied significantly across the tested D-dimer assays.
Conclusions:
- D-dimer testing is an effective pre-screening tool for DVT and PE.
- The VIDAS D-Dimer assay shows promise as a rapid diagnostic option.
- A combined strategy using routine latex and VIDAS D-Dimer offers the most efficient and cost-effective approach for DVT/PE screening.
Abstract:
DD are now recognized as a valuable tool to screen patients suspected of deep venous thrombosis or pulmonary embolism before carrying out a gold standard radiologic examination. The newest methods available claim to be able to ascertain the absence of thrombosis, but they have yet to prove their efficiency. We compared the performances of 3 reference ELISA methods (D-DI Asserachrom Stago, D-dimer Enzygnost Behring and Dimertest GOLD EIA Agen), 5 recent rapid methods (VIDAS D-Dimer bioMérieux, Instant IA Stago, Simplired Agen, Nycocard D-dimer Nycomed and Accuclot D-Dimer Sigma Diagnostics) and two routine latex methods (Dimertest American Diagnostica and FDP-Slidex bioMérieux) in 100 patients. One of the rapid quantitative methods was demonstrated to have a level of efficiency comparable to that of ELISA methods. Finally, the cost and efficiency of different strategies were evaluated, the association of a routine latex method with the VIDAS D-Dimer bioMérieux being proven to be the most efficient.