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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


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Volume 52, Issue 5

Issues

D-dimer testing for suspected venous thromboembolism in the emergency department. Consensus document of AcEMC, CISMEL, SIBioC, and SIMeL

Giuseppe Lippi
  • Corresponding author
  • Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
  • UO Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14 Parma 46124, Italy
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gianfranco Cervellin / Ivo Casagranda
  • Emergency Department, Santi Antonio e Biagio e Cesare Arrigo General Hospital, Alessandria, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Benedetto Morelli / Sophie Testa / Armando Tripodi
  • Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, IRCCS Cà Granda Maggiore Hospital Foundation and University of Milan, Milan, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-10-24 | DOI: https://doi.org/10.1515/cclm-2013-0706

Abstract

D-dimer testing is currently considered a cornerstone in the diagnostic approach of patients with suspected venous thromboembolism (VTE) across different health-care settings, including the emergency department (ED). Nevertheless, inappropriate or incorrect activities developing throughout the total testing process may substantially impair the clinical usefulness of this test and delay or even challenge the fast rule out or diagnosis of VTE. The leading problem of D-dimer is represented by the poor specificity for diagnosing VTE, wherein a minority of patients with a positive D-dimer are finally diagnosed with VTE, and even more importantly, the specificity further decreases with ageing, thus contributing to increase the overcrowding in short stay units such as the ED. Due to the large heterogeneity that characterizes the use of D-dimer in the emergency room, three Italian societies of laboratory medicine (Italian Committee for Standardization of Hematology and Laboratory Methods, Italian Society of Clinical Biochemistry and Molecular Biology, and Italian Society of Laboratory Medicine), along with the Academy of Emergency Medicine and Care, have developed a consensus document about the use of D-dimer testing for diagnostics of patients with suspected VTE in this health-care setting. The evidence-based indications contained in this document will cover the leading preanalytical, analytical, and postanalytical issues that may impair the clinical efficacy of D-dimer testing in the ED.

Keywords: D-dimer; deep vein thrombosis; emergency department; pulmonary embolism; venous thromboembolism

References

  • 1.

    Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations – United States, 2007–2009. MMWR Morb Mortal Wkly Rep 2012;61:401–4.Google Scholar

  • 2.

    Lippi G, Franchini M. Pathogenesis of venous thromboembolism: When the cup runneth over. Semin Thromb Hemost 2008;34:747–61.Web of SciencePubMedCrossrefGoogle Scholar

  • 3.

    Yusuf HR, Tsai J, Siddiqi A, Boulet SL, Soucie JM. Emergency department visits by patients with venous thromboembolism, 1998–2009. J Hosp Admin 2012;1:1–8.Google Scholar

  • 4.

    Lippi G, Cervellin G, Franchini M, Favaloro EJ. Biochemical markers for the diagnosis of venous thromboembolism: The past, present and future. J Thromb Thrombolysis 2010;30:459–71.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 5.

    Lippi G, Favaloro EJ, Plebani M. Proteomic analysis of venous thromboembolism. Expert Rev Proteomics 2010;7:275–82.PubMedCrossrefGoogle Scholar

  • 6.

    Bates SM. D-dimer assays in diagnosis and management of thrombotic and bleeding disorders. Semin Thromb Hemost 2012;38:673–82.Web of SciencePubMedGoogle Scholar

  • 7.

    Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, et al. PROLONG investigators. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006;355:1780–9.Google Scholar

  • 8.

    Lippi G, Bonfanti L, Saccenti C, Cervellin G. Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med 2013. DOI: 10.1016/j.ejim.2013.07.012 [Epub ahead of print].CrossrefGoogle Scholar

  • 9.

    Tripodi A. D-dimer testing in laboratory practice. Clin Chem 2011;57:1256–62.PubMedCrossrefGoogle Scholar

  • 10.

    Olson JD, Cunningham MT, Higgins RA, Eby CS, Brandt JT. D-dimer: simple test, tough problems. Arch Pathol Lab Med 2013;137:1030–8.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 11.

    Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I. Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 2013;18:129–38.PubMedGoogle Scholar

  • 12.

    Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: Increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416–20.PubMedGoogle Scholar

  • 13.

    Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: The revised Geneva score. Ann Intern Med 2006;144:165–71.PubMedGoogle Scholar

  • 14.

    National Institute for Health and Care Excellence. CG144 venous thromboembolic diseases: Two-level Wells score – templates for deep vein thrombosis and pulmonary embolism. Available from: http://guidance.nice.org.uk/CG144/TemplateWellsScore/doc/English. Accessed 29 August, 2013.

  • 15.

    Legnani C, Palareti G, Prisco D, Mannucci PM, Tripodi A, Ciavarella N, et al., per il Sottocomitato Emostasi del CISMEL. Linee guida sull’impiego clinico del D-dimero. Riv Med Lab – JLM 2004;5:225–38.Google Scholar

  • 16.

    Linkins LA, Bates SM, Lang E, Kahn SR, Douketis JD, MMath JJ, et al. Selective D-dimer testing for diagnosis of a first suspected episode of deep venous thrombosis. A randomized trial. Ann Intern Med 2013;158:93–100.CrossrefGoogle Scholar

  • 17.

    Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, et al., American College of Chest Physicians. Diagnosis of DVT: Antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e351S–418S.Google Scholar

  • 18.

    Lippi G, Plebani M. False myths and legends in laboratory diagnostics. Clin Chem Lab Med 2013;51:2087–97.Web of SciencePubMedGoogle Scholar

  • 19.

    Lucassen W, Geersing GJ, Erkens PM, Reitsma JB, Moons KG, Büller H, et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 2011;155: 448–60.CrossrefGoogle Scholar

  • 20.

    Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29:2276–315.PubMedGoogle Scholar

  • 21.

    Penaloza A, Verschuren F, Meyer G, Quentin-Georget S, Soulie C, Thys F, et al. Comparison of the unstructured clinician gestalt, the Wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med 2013;62:117–24.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 22.

    Lippi G, Becan-McBride K, Behúlová D, Bowen RA, Church S, Delanghe J, et al. Preanalytical quality improvement: In quality we trust. Clin Chem Lab Med 2013;51:229–41.Web of SciencePubMedGoogle Scholar

  • 23.

    Blombäck M, Konkle BA, Manco-Johnson MJ, Bremme K, Hellgren M, Kaaja R, ISTH SSC Subcommittee on Women′s Health Issues. Preanalytical conditions that affect coagulation testing, including hormonal status and therapy. J Thromb Haemost 2007;5:855–8.CrossrefWeb of ScienceGoogle Scholar

  • 24.

    Lippi G, Salvagno GL, Guidi GC. No influence of a butterfly device on routine coagulation assays and D-dimer measurement. J Thromb Haemost 2005;3:389–91.CrossrefPubMedGoogle Scholar

  • 25.

    Lippi G, Salvagno GL, Montagnana M, Poli G, Guidi GC. Influence of the needle bore size on platelet count and routine coagulation testing. Blood Coagul Fibrinolysis 2006;17:557–61.CrossrefPubMedGoogle Scholar

  • 26.

    Clinical and Laboratory Standards Institute. Collection, transport, and processing of blood specimens for testing plasma-based coagulation assays and molecular hemostasis assays: approved guideline, 5th ed. CLSI document H21-A5. Wayne, PA: Clinical and Laboratory Standards Institute, 2008.Google Scholar

  • 27.

    Lippi G, Cervellin G. Choosing troponin immunoassays in a world of limited resources. J Am Coll Cardiol 2013;62:647–8.Web of ScienceCrossrefGoogle Scholar

  • 28.

    Favaloro EJ, Plebani M, Lippi G. Regulation in hemostasis and thrombosis: Part I – in vitro diagnostics. Semin Thromb Hemost 2013;39:235–49.PubMedGoogle Scholar

  • 29.

    Salvagno GL, Lippi G, Montagnana M, Poli G, Giavarina D, Manzato F, et al. Performance of the automated and rapid HemosIL D-Dimer HS on the ACL TOP analyzer. Blood Coagul Fibrinolysis 2008;19:817–21.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 30.

    Niemann T, Zbinden I, Roser H, Bremerich J, Remy-Jardin M, Bongartz G. Computed tomography for pulmonary embolism: Assessment of a 1-year cohort and estimated cancer risk associated with diagnostic irradiation. Acta Radiol 2013;54:778–84.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 31.

    Jackson BP, McCloskey LJ, Stickle DF. Investigation of a slope discontinuity in a patients’ results distribution for D-dimer. Clin Chem Lab Med 2012;50:2243–5.Web of ScienceGoogle Scholar

  • 32.

    Casagranda I, Cavazza M, Clerico A, Galvani M, Ottani F, Zaninotto M, et al. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation. Clin Chem Lab Med 2013;51:1727–37.Web of SciencePubMedGoogle Scholar

  • 33.

    Plebani M, Favaloro EJ, Lippi G. Patient safety and quality in laboratory and hemostasis testing: A renewed loop? Semin Thromb Hemost 2012;38:553–8.PubMedWeb of ScienceGoogle Scholar

  • 34.

    Plebani M, Chiozza ML, Sciacovelli L. Towards harmonization of quality indicators in laboratory medicine. Clin Chem Lab Med 2013;51:187–95.PubMedGoogle Scholar

  • 35.

    Lippi G, Plebani M, Favaloro EJ. Interference in coagulation testing: focus on spurious hemolysis, icterus, and lipemia. Semin Thromb Hemost 2013;39:258–66.PubMedWeb of ScienceGoogle Scholar

  • 36.

    Lippi G, Avanzini P, Zobbi V, Ippolito L. Influence of mechanical hemolysis of blood on two D-dimer immunoassays. Blood Coagul Fibrinolysis 2012;23:461–3.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 37.

    Lippi G, Mattiuzzi C, Cervellin G. Point of care troponin testing: rules and regulations. J Electrocardiol 2013. DOI: 10.1016/j.jelectrocard.2013.04.001 [Epub ahead of print].CrossrefWeb of SciencePubMedGoogle Scholar

  • 38.

    Lippi G, Franchini M, Targher G, Favaloro EJ. Help me, doctor! My D-dimer is raised. Ann Med 2008;40:594–605.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 39.

    Schouten HJ, Geersing GJ, Koek HL, Zuithoff NP, Janssen KJ, Douma RA, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: Systematic review and meta-analysis. Br Med J 2013;346:f2492.Google Scholar

  • 40.

    Legnani C, Cini M, Cosmi B, Carraro P, Tripodi A, Erba N, et al. Age and gender specific cut-off values to improve the performance of D-dimer assays to predict the risk of venous thromboembolism recurrence. Intern Emerg Med 2013;8: 229–36.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 41.

    Verma N, Willecke P, Bicsàn P, Pavenstädt H, Kümpers P. [Age-adjusted D-dimer cut-offs to diagnose thromboembolic events. Validation in an emergency department]. Med Klin Intensivmed Notfmed 2013. DOI: 10.1007/s00063-013-0265-8 [Epub ahead of print, in German].CrossrefGoogle Scholar

  • 42.

    Douma RA, le Gal G, Söhne M, Righini M, Kamphuisen PW, Perrier A, et al. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: A retrospective analysis of three large cohorts. Br Med J 2010;340:c1475.Web of ScienceGoogle Scholar

  • 43.

    Crowther MA, Bates SM, Keeney M, Raby A, Flynn G. Human-derived D-dimer for external quality assessment: Results of four surveys in Ontario. Am J Clin Pathol 2008;130: 805–10.PubMedCrossrefGoogle Scholar

  • 44.

    Tripodi A, Chantarangkul V. Performance of quantitative D-dimer methods. Results of the italian external quality assessment scheme. J Thromb Haemost 2007;5:184–5.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 45.

    Lippi G, Favaloro EJ. D-dimer measurement and laboratory feedback. J Emerg Med 2009;37:82–3.Web of ScienceCrossrefPubMedGoogle Scholar

About the article

Corresponding author: Giuseppe Lippi, UO Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14 Parma 46124, Italy, Phone: +39-521-703050, Fax: +39-521-703791, E-mail:


Received: 2013-08-29

Accepted: 2013-09-28

Published Online: 2013-10-24

Published in Print: 2014-05-01


Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 52, Issue 5, Pages 621–628, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-0706.

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