The usefulness of five D-dimer assays in the exclusion of deep venous thrombosis

Abstract

D-Dimer measurement is a promising tool in the exclusion of venous thrombosis. New D-dimer assays have been introduced, but need clinical validation. Our objective was to evaluate the clinical usefulness of four relatively new D-dimer assays and a classical ELISA in outpatients suspected for deep venous thrombosis. In 537 patients, participants in a large prospective management study using a clinical probability score and a D-dimer measurement (Tina-quant®), additional samples were taken for D-dimer measurement using the Asserachrom ELISA®, the VIDAS New®, the STA-LIA® and the Miniquant® assay. Performances of each test were calculated using clinical data during a 3-month follow-up. Thrombosis was detected in 224 patients (42%). The area under the ROC curve was significantly higher for the Tina-quant as compared to the other assays. Using standard cut-off values, sensitivity, negative predictive value (NPV) and specificity of the Asserachrom were 97, 94 and 33%, respectively. For the VIDAS New, values were 100, 96 and 8%, respectively. The Tina-quant showed values of 99, 98 and 41%, respectively, and the STA-LIA 98, 95 and 32%. Values for the Miniquant were 95, 94 and 52%. The D-dimer assays in our study all show a high sensitivity and negative predictive value, but none of the assays reached an NPV of > 98% at standard cut-off values. D-Dimer assays with a low specificity still necessitate additional diagnostic tests in the majority of the patients. © 2003 International Society on Thrombosis and Haemostasis.