The role of D-Dimer in the diagnosis of venous thromboembolism

Abstract

Evidence has accumulated confirming the accuracy and cost-effectiveness of incorporating a D-Dimer assay into the diagnostic algorithm of DVT and PE. The rapid ELISA Vidas® D-Dimer assay has high sensitivity and NPV for DVT. A negative result rules out proximal vein DVT in all patients. The SimpliRED assay is the only point-of-care D-Dimer test to undergo prospective evaluation in large studies of DVT. This assay is less sensitive but its NPV is high enough to rule out DVT in low-risk patients. Other sensitive assays such as the MDA DD, Tinaquant, Liatest, IL-DD, and Instant IA need further prospective evaluation in large management studies. In high-risk patients, only the Vidas D Dimer has an NPV sufficiently high to rule out DVT. However, most management studies of high-risk patients have recommended a combined, sequential approach utilizing a D-Dimer assay, US, and venography to rule out DVT. Individual results with one assay cannot be extrapolated to another at the present time. Standardization of the D-Dimer assays has not yet been achieved. Further prospective evaluation in large management trials are needed to further evaluate the use of D-Dimer assays in the diagnosis of venous thromboembolism.