Is antecedent D-Dimer testing prior to compression ultrasonography likely to be helpful for evaluating deep vein thrombosis in acute medical inpatients?
Anthony Ernest Robinson, Trish Pallathil, Sujatha Kawryshanker, Mark Teh
Abstract
Background
Venous thromboembolism is a preventable cause of death in hospital, D-Dimer assays are highly sensitive for detecting VTE but have not been validated in inpatients. Acute medical inpatients frequently have comorbid conditions that may limit the value of this test.
Aim
We aim to review the evidence regarding D-Dimer use and apply it to an acute medical inpatient cohort to determine its potential applicability in this setting.
Methods
A retrospective review of acute medical inpatients (within 48h of admission) was performed over a two year period who had compression ultrasonography. For patients without antecedent D-Dimer testing, medical records were reviewed to determine if a comorbid illness was present that would limit D-Dimer value. Pregnancy, active malignancy, significant infection, known arterial thrombus, VTE already detected, stage 4 CKD, age >80, exacerbation of moderate to severe COPD and clinical question of collection, not DVT, were accepted reasons that justified no D-Dimer.
Results
Three hundred and forty eight acute medical inpatients underwent DVT ultrasonography in this timeframe, 60 had confirmed DVT. 10.6 per cent of cases underwent antecedent D-Dimer testing, and a valid medical reason was identified in 84.9 per cent of cases who did not. Elderly age, significant infection and admission with active malignancy were the most common reasons to not proceed with D-Dimer testing.
Conclusion
Most acute medical inpatients proceeded straight to ultrasonography to evaluate for DVT which is largely supported by available literature. This study supports the limited, if any, role for antecedent D-Dimer use in acute medical inpatients due to their comorbid conditions.
Full Text:
Venous thromboembolism is a preventable cause of death in hospital, D-Dimer assays are highly sensitive for detecting VTE but have not been validated in inpatients. Acute medical inpatients frequently have comorbid conditions that may limit the value of this test.
Aim
We aim to review the evidence regarding D-Dimer use and apply it to an acute medical inpatient cohort to determine its potential applicability in this setting.
Methods
A retrospective review of acute medical inpatients (within 48h of admission) was performed over a two year period who had compression ultrasonography. For patients without antecedent D-Dimer testing, medical records were reviewed to determine if a comorbid illness was present that would limit D-Dimer value. Pregnancy, active malignancy, significant infection, known arterial thrombus, VTE already detected, stage 4 CKD, age >80, exacerbation of moderate to severe COPD and clinical question of collection, not DVT, were accepted reasons that justified no D-Dimer.
Results
Three hundred and forty eight acute medical inpatients underwent DVT ultrasonography in this timeframe, 60 had confirmed DVT. 10.6 per cent of cases underwent antecedent D-Dimer testing, and a valid medical reason was identified in 84.9 per cent of cases who did not. Elderly age, significant infection and admission with active malignancy were the most common reasons to not proceed with D-Dimer testing.
Conclusion
Most acute medical inpatients proceeded straight to ultrasonography to evaluate for DVT which is largely supported by available literature. This study supports the limited, if any, role for antecedent D-Dimer use in acute medical inpatients due to their comorbid conditions.
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