Faculty of Medicine, University of Oslo, Oslo, Norway; Clinic of Internal Medicine, Østfold Hospital, Sarpsborg, Norway.
Clinic of Internal Medicine, Østfold Hospital, Sarpsborg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Thromb Res. 2022 Aug;216:22-24. doi: 10.1016/j.thromres.2022.05.017. Epub 2022 Jun 6.
Empiric anticoagulation therapy is often used in patients with suspected deep vein thrombosis (DVT) to avoid complications if the workup is delayed. Studies have shown the safety of administering direct oral anticoagulants (DOACs) and low molecular weight heparin in patients with suspected DVT. However, the impact of empiric DOACs on D-dimer levels in patients with suspected DVT is not well established. Therefore, this study aimed to determine the effect of empiric rivaroxaban on the diagnostic performance of D-dimer.
D-dimer was measured before and after the administration of one to two tablets of rivaroxaban in 418 patients referred with suspected DVT to the Emergency Department at Østfold Hospital, Norway. To determine whether the effect of rivaroxaban significantly impacted D-dimer results, we calculated the diagnostic performance of the test before and after patients had taken rivaroxaban. All patients with negative workup were followed up at 90 days.
Two hundred eighty-six (68.4 %) of the 418 included patients had lower D-dimer results after taking rivaroxaban. Median D-dimer values decreased from 1.0 mg/L (IQR: 0.7-2.2) to 0.9 mg/L (IQR: 0.6-2.0). Thirty-six patients (8.9 %) with positive D-dimer (≥ 0.5 mg/L fibrinogen-equivalent units) before taking rivaroxaban had negative D-dimer values after rivaroxaban intake. Of these, two had DVT diagnosed by compression ultrasonography. The sensitivity of D-dimer decreased from 99.0 % (95 % CI: 94.6-99.8) to 97.0 % (95 % CI: 91.6-99.0).
Rivaroxaban administered before measuring D-dimer may reduce the sensitivity and increase false negative results of the test. Based on these results, we recommend performing D-dimer before the administration of rivaroxaban.
在疑似深静脉血栓形成（DVT）患者中，常采用经验性抗凝治疗以避免因检查延迟而产生并发症。研究表明，在疑似 DVT 患者中使用直接口服抗凝剂（DOACs）和低分子肝素是安全的。然而，经验性 DOACs 对疑似 DVT 患者 D-二聚体水平的影响尚未得到充分证实。因此，本研究旨在确定经验性利伐沙班对 D-二聚体诊断性能的影响。
在挪威奥斯特福德医院急诊科就诊的疑似 DVT 患者中，418 例患者在服用一片或两片利伐沙班前后测量了 D-二聚体。为了确定利伐沙班对 D-二聚体结果的影响是否显著，我们在患者服用利伐沙班前后计算了该检测的诊断性能。所有阴性检查结果的患者均在 90 天进行随访。
418 例患者中有 286 例（68.4%）服用利伐沙班后 D-二聚体结果降低。中位 D-二聚体值从 1.0mg/L（IQR：0.7-2.2）降至 0.9mg/L（IQR：0.6-2.0）。36 例（8.9%）服用利伐沙班前 D-二聚体阳性（≥0.5mg/L 纤维蛋白原等价单位）的患者在服用利伐沙班后 D-二聚体值转为阴性。其中，2 例经压迫超声检查诊断为 DVT。D-二聚体的敏感性从 99.0%（95%CI：94.6-99.8）降至 97.0%（95%CI：91.6-99.0）。
在测量 D-二聚体之前使用利伐沙班可能会降低该检测的敏感性并增加假阴性结果。基于这些结果，我们建议在使用利伐沙班前进行 D-二聚体检测。
