 Volver caso práctico nº 4 |
| TITLE: | Quantitative plasma D-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism [see comments] | ||||||
|---|---|---|---|---|---|---|---|
| AUTHORS: | Goldhaber SZ; Simons GR; Elliott CG; Haire WD; Toltzis R; Blacklow SC; Doolittle MH; Weinberg DS | ||||||
| AUTHOR AFFILIATION: | Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. | ||||||
| SOURCE: | JAMA 1993 Dec 15;270(23):2819-22 | ||||||
| CITATION IDS: | PMID: 8133620 UI: 94180499 | ||||||
| COMMENT: | Comment in: JAMA 1994 May 11;271(18):1404 | ||||||
| ABSTRACT: | OBJECTIVE--To test the hypothesis that a low D-dimer level has a high negative predictive value for acute pulmonary embolism (PE) among patients undergoing diagnostic pulmonary angiography. DESIGN--Blinded comparison of quantitative plasma D-dimer levels, measured using a monoclonal antibody assay, with pulmonary angiographic results from 173 patients with suspected acute PE. SETTING--Tertiary care setting at fur participating institutions. PATIENTS--Plasma samples were analyzed in 173 patients who underwent diagnostic pulmonary arteriography for suspected acute PE. MAIN OUTCOME MEASURES--Sensitivity, specificity, and predictive values of quantitative plasma D-dimer levels for the diagnosis of PE, using pulmonary angiographic data as the criterion standard test. RESULTS--Of 35 patients with D-dimer values less than 500 ng/mL, only three had abnormal pulmonary angiograms. The negative predictive value of a plasma D-dimer level less than 500 ng/mL for acute PE was 91.4% (95% confidence interval [CI], 76.9% to 98.2%). D- dimer levels were greater than 500 ng/mL in 42 of 45 patients with PE and in 96 of 128 patients without PE (P = .016). Sensitivity, specificity, and positive predictive value of a plasma D-dimer level greater than 500 ng/mL for acute PE were 93.3% (95% CI, 81.7% to 98.6%), 25.0% (95% CI, 17.5% to 32.5%), and 30.4% (95% CI, 22.8% to 38.1%), respectively. CONCLUSIONS--The results of our study indicate that quantitative plasma D-dimer levels can be useful in screening patients with suspected PE who require pulmonary angiography. Plasma D- dimer values less than 500 ng/mL may obviate the need for pulmonary angiography, particularly among medical patients for whom the clinical suspicion of PE is low. The plasma D-dimer value, assayed using a commercially available enzyme-linked immunosorbent assay kit, is a sensitive but nonspecific test for the presence of acute PE. | ||||||
| MAIN MESH HEADINGS: |
Antifibrinolytic Agents/*blood Fibrin Fibrinogen Degradation Products/*analysis Pulmonary Embolism/*blood Pulmonary Embolism/*radiography | ||||||
| ADDITIONAL MESH HEADINGS: |
Adult Aged Angiography Comparative Study Enzyme-Linked Immunosorbent Assay/methods Female Human Male Middle Age Predictive Value of Tests Sensitivity and Specificity Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. | ||||||
| PUBLICATION TYPES: | JOURNAL ARTICLE | ||||||
| CAS REGISTRY NUMBERS: |
0 (fibrin fragment D) 0 (Antifibrinolytic Agents) 0 (Fibrin Fibrinogen Degradation Products) | ||||||
| LANGUAGES: | Eng | ||||||
| GRANT/CONTRACT ID: | M01 RR02635/RR/NCRR | ||||||
|
Volver caso práctico nº 4 |