Bernardi E, Prandoni P, Lensing A W, Agnelli G, Guazzaloca G, Scannapieco G, Piovella F, Verlato F, Tomasi C, Moia M, Scarano L, Girolami A
Istituto di Semeiotica Medica, University of Padua, 35128 Padua, Italy.
BMJ. 1998 Oct 17;317(7165):1037-40. doi: 10.1136/bmj.317.7165.1037.
To investigate the efficacy of using a rapid plasma D-dimer test as an adjunct to compression ultrasound for diagnosing clinically suspected deep vein thrombosis.
D-dimer concentrations were determined in all patients with a normal ultrasonogram at presentation. Repeat ultrasonography was performed 1 week later only in patients with abnormal D-dimer test results.
Patients with normal ultrasonograms were not treated with anticoagulants and were followed for 3 months for thromboembolic complications.
University research and affiliated centres.
946 patients with clinically suspected deep vein thrombosis.
Ultrasonograms were abnormal at presentation in 260 (27.5%) patients. Of the remaining 686 patients tested for D-dimer, 88 (12.8%) had abnormal concentrations. During follow up venous thromboembolic complications occurred in one of the 598 patients who were not treated with anticoagulants and who had an initial normal ultrasonogram and D-dimer concentration, whereas thromboembolic complications occurred in two of the 83 untreated patients who had abnormal D-dimer concentrations but a normal repeat ultrasonogram. The cumulative incidence of venous thromboembolic complications during follow up was 0.4% (95% confidence interval 0% to 0.9%). The rapid plasma D-dimer test used as an adjunct to compression ultrasonography resulted in a reduction in the mean number of repeat ultrasound examinations and additional hospital visits from 0.7 to 0.1 per patient.
Testing for D-dimer as an adjunct to a normal baseline ultrasound examination decreased the number of subsequent ultrasound examinations considerably without any increased risk of venous thromboembolic complications in patients not receiving anticoagulants. The use of ultrasound and testing for D-dimer enabled treatment decisions to be made at the time of presentation in most patients.
研究快速血浆D-二聚体检测作为压缩超声检查辅助手段用于诊断临床疑似深静脉血栓形成的疗效。
对所有初次超声检查正常的患者测定D-二聚体浓度。仅对D-二聚体检测结果异常的患者在1周后进行重复超声检查。
超声检查正常的患者不接受抗凝治疗，并随访3个月以观察血栓栓塞并发症。
大学研究机构及附属中心。
946例临床疑似深静脉血栓形成的患者。
初次检查时260例（27.5%）患者超声检查异常。在其余686例接受D-二聚体检测的患者中，88例（12.8%）浓度异常。在随访期间，598例未接受抗凝治疗、初次超声检查及D-二聚体浓度正常的患者中有1例发生静脉血栓栓塞并发症，而83例未接受治疗、D-二聚体浓度异常但重复超声检查正常的患者中有2例发生血栓栓塞并发症。随访期间静脉血栓栓塞并发症的累积发生率为0.4%（95%置信区间0%至0.9%）。快速血浆D-二聚体检测作为压缩超声检查的辅助手段，使每位患者重复超声检查及额外住院就诊的平均次数从0.7次降至0.1次。
D-二聚体检测作为正常基线超声检查的辅助手段，可显著减少后续超声检查次数，且未接受抗凝治疗的患者发生静脉血栓栓塞并发症的风险未增加。超声检查和D-二聚体检测的联合应用使大多数患者在就诊时即可做出治疗决策。
