Elías-Hernández T, Otero-Candelera R, Fernández-Jiménez D, Jara-Palomares L, Jiménez-Castro V, Barrot-Cortés E
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Clin Esp. 2012 May;212(5):235-41. doi: 10.1016/j.rce.2012.02.002. Epub 2012 Apr 3.
The diagnostic approach in outpatients with suspected deep vein thrombosis (DVT) of the lower limbs includes D-dimer measurement (DD). Elevated DD is not a diagnostic value for DVT. However, a normal value contributes to ruling out DVT. We do not know the best method to determine DD. Therefore, we have analyzed the clinical utility of three quantitative assays to determine DD in outpatients with suspected DVT.
Consecutive outpatients with suspected DVT of the lower limbs who were referred to the DVT medical consultation were enrolled in the study. We used a diagnostic algorithm that included determining the pretest clinical probability (PCP) (Wells scale), DD level using three different quantitative methods (ELISA mini-VIDAS(®), Acure-care DDMR and DD-Plus). The DVT diagnosis was confirmed by seriated compression ultrasonography of the lower limbs. We analyzed the concordance between the three analytic methods to quantify DD and the characteristics.
A total of 306 patients (mean age 60 years, 62% women) with suspected DVT of the lower limbs were included. The compression ultrasonography confirmed the diagnosis of DVT in 23.8% of the patients. Anticoagulation treatment was not performed in patients in whom DVT was ruled out, and no thromboembolic event occurred during the 3 months of follow-up. The best concordance test results were between ELISA mini-VIDAS(®) and Acure-care DDMR assays. Both assays demonstrated elevated sensibility and a negative predictive value. ELISA mini-VIDAS(®) was the best analytic method for the subgroup of patients with low clinical probability.
The ELISA mini-VIDAS(®) method to determine DD rules out DVT in patients with low clinical probability.
下肢深静脉血栓形成（DVT）疑似门诊患者的诊断方法包括D - 二聚体检测（DD）。DD升高对DVT并无诊断价值。然而，其正常数值有助于排除DVT。我们并不清楚测定DD的最佳方法。因此，我们分析了三种定量检测方法在下肢DVT疑似门诊患者中测定DD的临床效用。
连续纳入被转诊至DVT医疗咨询门诊的下肢DVT疑似门诊患者。我们采用了一种诊断算法，其中包括确定检测前临床概率（PCP）（Wells量表），使用三种不同定量方法（ELISA mini - VIDAS(®)、Acure - care DDMR和DD - Plus）测定DD水平。通过下肢系列加压超声检查确诊DVT。我们分析了三种定量DD分析方法之间的一致性及其特点。
共纳入306例下肢DVT疑似患者（平均年龄60岁，62%为女性）。加压超声检查确诊23.8%的患者患有DVT。排除DVT的患者未进行抗凝治疗，在3个月的随访期间未发生血栓栓塞事件。ELISA mini - VIDAS(®)与Acure - care DDMR检测之间的一致性检验结果最佳。两种检测方法均显示出较高的敏感性和阴性预测值。ELISA mini - VIDAS(®)是临床概率较低患者亚组的最佳分析方法。
ELISA mini - VIDAS(®)测定DD的方法可排除临床概率较低患者的DVT。
