D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis.

Abstract

BACKGROUND:

D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT).

AIM:

To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT.

STUDY DESIGN:

We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: ≤500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism.

RESULTS:

We enrolled 239 patients (F: 63.6%; mean±SD age: 58.3±16.8). At the initial diagnostic work-up, DVT was detected in 24 (10%) patients while SVT in 35 (14.6%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92% (95%CI: 73-99%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 98% (95%CI: 93-100%), whereas for SVT they were 77% (95%CI: 59-89%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 93% (95%CI: 86-97%).

CONCLUSIONS:

D-dimer has a negative predictive value ≥93% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT.

• Authors: Michelangelo Sartori, Ludovica Migliaccio, Elisabetta Favaretto, Michela Cini, Cristina Legnani, Gualtiero Palareti, Benilde Cosmi
• Journal: Thrombosis research (Thromb Res) Vol. 135 Issue 4 Pg. 673-8 (Apr 2015) ISSN: 1879-2472 [Electronic] United States
• PMID: 25700619 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Antifibrinolytic Agents
• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• Antifibrinolytic Agents (administration & dosage, therapeutic use)
• Female
• Fibrin Fibrinogen Degradation Products (administration & dosage, therapeutic use)
• Humans
• Male
• Prospective Studies
• Ultrasonography
• Upper Extremity Deep Vein Thrombosis (diagnostic imaging, drug therapy)