Potu Kalyan Chakravarthy, Ketineni Sujithasree, Lamfers Randall
Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Department of Internal Medicine, Sri Venkata Sai Medical College, Andhra Pradesh, India.
S D Med. 2016 Sep;69(9):414-417.
Given the high incidence of deep vein thrombosis/pulmonary embolism (DVT/PE) (300,000 to 600,000 per year in the U.S.) and the 30 percent mortality rate associated with undiagnosed PE, diagnostic evaluation is very important. One of the tools used to evaluate for DVT and PE is D-dimer testing. A negative D-dimer test, along with a low Wells clinical probability score, can safely rule out DVT/PE without the need for additional imaging. This approach can reduce cost; however, D-dimer testing is not indicated in all patients. D-dimers can be elevated in patients without DVT/PE, like the elderly. The consequences of over utilizing D-dimer testing can lead to excessive imaging, unnecessary contrast exposure, unnecessary exposure to radiation, and increased cost. In this primer, we provide a brief literature review of D-dimer testing for the diagnosis of DVT and PE. We also discuss the overutilization of D-dimer testing and its financial burden on the health care industry.
鉴于深静脉血栓形成/肺栓塞（DVT/PE）的高发病率（在美国每年有30万至60万例）以及未确诊的PE相关的30%死亡率，诊断评估非常重要。用于评估DVT和PE的工具之一是D-二聚体检测。D-二聚体检测结果为阴性，再加上Wells临床概率评分较低，可以安全地排除DVT/PE，而无需进行额外的影像学检查。这种方法可以降低成本；然而，并非所有患者都需要进行D-二聚体检测。在没有DVT/PE的患者中，如老年人，D-二聚体可能会升高。过度使用D-二聚体检测的后果可能导致过度的影像学检查、不必要的造影剂暴露、不必要的辐射暴露以及成本增加。在本入门指南中，我们简要回顾了用于诊断DVT和PE的D-二聚体检测的文献。我们还讨论了D-二聚体检测的过度使用及其对医疗行业的经济负担。
