正常なD-ダイマー濃度と非高いプレテスト臨床確率スコアの組み合わせは,深静脈血栓症を除外するための安全な戦略です
R E G Schutgens1, P Ackermark, F J L M Haas
1Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. schutgensvos@hetnet.nl
Circulation
|February 5, 2003
まとめ
低度のプレテストの臨床確率スコアと通常のD-ダイマー検査を組み合わせると,深静脈血栓症を安全に排除できます. この戦略は,超音波検査の必要性を減らし,患者の快適性を向上させ,コストを削減します.
科学分野:
- 医療診断 医療診断
- 心血管医学 心血管医学
- トロンボシス研究研究
背景:
- 連続超音波検査は,症状のある患者の深静脈血栓症 (DVT) の信頼性の高い診断ツールです.
- しかし,症状のある個体におけるDVTの低罹患率は,連続超音波検査を高価で不便なものにしています.
- この研究では,先行試験の臨床確率スコアとD-ダイマーテストを組み合わせて初期DVT評価を行うことの臨床的妥当性を調査した.
研究 の 目的:
- 深静脈血栓症 (DVT) の診断戦略の安全性と有効性を評価する.
- DVTの疑いのある患者におけるプレテスト臨床確率スコアとD-ダイマー検査の組み合わせを評価する.
- この戦略がDVTを無事に排除し,シリアル超音波検査への依存を減らすことができるかどうかを判断する.
主な方法:
- 患者は,プレテストの臨床確率スコア (高または非高) とD-ダイマー濃度 (正常または異常) に基づいて階層化されました.
- 検査プロトコルは様々であった:正常なD-ジメールと非高い確率のさらなる検査は不要であった;正常なD-ジメールと高い確率の1回の超音波検査;異常なD-ジメールの連続超音波検査.
- 患者を3ヶ月間追跡して,血栓形成の進行を評価した.
主要な成果:
- 正常なD-ダイマーと非高確率スコアを有する患者の0.6%のみが,血栓形成を発症した.
- D-ダイマー異常を有する患者では,超音波検査で51.3%で血栓が検出され,フォローアップ中に血栓が発症した患者は2.1%でした.
- 組み合わせられた戦略により,全般的な超音波検査の必要性は29%減少しました.
結論:
- 臨床的確率スコアが高くないプレテストと正常なD-ダイマー濃度の組み合わせは,深静脈血栓症を除外するための安全なアプローチです.
- この戦略により,低リスクの患者に抗凝固剤を差し控えることができます.
- この発見は,DVTの疑いに対するより効率的な診断経路を支持し,不必要な画像処理を削減します.
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