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The ROC curve of the 4 PTP scores for the diagnosis of DVT. DVT indicates deep venous thrombosis; PTP, pretest probability; ROC, receiver–operator characteristic.
Source publication
This study seeks to evaluate the diagnostic value of D-Dimer Plus and Innovance D-Dimer as well as the age-adjusted cutoff value for D-dimer detection in combination with 4 pretest probability (PTP) scores for deep venous thrombosis (DVT). A total of 688 patients referred for lower extremity vascular compression venous ultrasonography for suspected...
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Lower extremity venous thrombosis is a risky condition that may cause crucial complications including pulmonary embolism and post-thrombotic syndrome. May-Thurner syndrome is a venous compression syndrome resulting in compression of the left common iliac vein by the overriding right iliac artery. In this case, left common iliac vein compression ari...
Several anatomic abnormalities predispose patients to iliofemoral deep venous thrombosis, the most common of which is compression of the left iliac vein between the right common iliac artery and lumbar vertebrae, or May-Thurner syndrome. Other areas of venous compression can occur but are rare. This case report describes the presentation, diagnosis...
Citations
... 27,28 Schouten et al 29 were able to effectively exclude DVT by adjusting the age-adjusted D-dimer threshold in 647 patients rated as low risk, especially in those older than 60 years. Similar results were also shown by Li et al. 30 In order to validate the diagnostic efficacy of the age-adjusted D-dimer threshold with its combined modified Wells score in patients with early lower extremity DVT, a subgroup analysis was performed according to the cause of admission. The age-adjusted D-dimer threshold combined with the modified Wells score retained high diagnostic value among the subgroups but without significant differences, similar to Douma et al. 26 Such results might be related to the small sample size. ...
Background
Neurosurgical patients are at an increased risk of deep venous thrombosis (DVT), which, if not properly managed, can lead to pulmonary embolism. This study aimed to investigate the accuracy of age-adjusted D-dimer thresholds combined with the modified Wells score as a predictor for lower extremity DVT diagnosis.
Methods
We conducted a study among patients aged >50 years with suspected lower extremity DVT in the neurosurgery intensive care unit between December 2019 and December 2020. Receiver operating characteristic curve analysis was performed to examine the diagnostic capacity of age-adjusted D-dimer combined with the modified Wells score.
Results
A total of 233 participants, with an average age of 71.81 ± 12.59 years, were enrolled in the study. The mean D-dimer levels were 0.73 ± 0.39 mg/L. Among the participants, 57 (57.9%, 33 males) were diagnosed with DVT. The age-adjusted D-dimer combined with the modified Wells score had the highest area under the curve for diagnosing lower extremity DVT compared to D-dimer and age-adjusted D-dimer alone, with an AUC of 0.858. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the age-adjusted D-dimer combined with the modified Wells score for DVT diagnosis were 78.95%, 80.68%, 57%, 92.2%, and 80.26%, respectively. When analyzing subgroups, the accuracy was 79.55% for participants with cerebral hemorrhage, 81.69% for those with craniocerebral injury, 74.99% for participants with intracranial infection, and 88.89% for those with craniocerebral tumor.
Conclusion
The combination of the age-adjusted D-dimer thresholds with the modified Wells score might effectively predict lower extremity DVT.
... When employing D-dimer, many studies have taken various measures to improve the diagnostic value of D-dimer. 23,31,32 Ke et al. used a respective cut-off value of D-dimer in subgroups and elevated the diagnostic ability of D-dimer in lung cancer patients after surgery. 23 In the present study, we performed a separate ROC analysis in order to determine the cut-off value in subgroups. ...
Objective
To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries.
Methods
A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening.
Results
Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group.
Conclusions
D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.
... Along with imaging investigations, laboratory tests are an essential part of supporting or refuting a diagnosis. It is the case of the detection of D-dimers, a practice often used especially when suspecting a venous thrombosis located in the lower limbs [13], this measurement bringing benefits also in the case of a CVT. According to recent studies, it is recommended to measure the level of D-dimers before neuroimaging examination in patients with suspected CVT [14], a high level of D-dimers being an additional argument for performing costly imaging examination such as MRI venography. ...
Cerebral venous thrombosis (CVT), although accounting for only 0.5-1% of all strokes, remains a potentially fatal neurological emergency, which must be promptly diagnosed and treated. Consisting of two parts, this review aims to highlight the most important data from recent years regarding diagnosis and treatment of CVT, illustrating both the current modern therapeutic approach and the future research directions in the field. Regarding the clinical diagnosis, the neurologist may sometimes have difficulties in recognizing this pathology, given the diverse clinical picture of the acute stage of CVT that can mimic various neurological disorders. In addition, although most risk factors (procoagulation status, infections, trauma, systemic diseases) are known and can be easily detected, in a significant percentage of cases the etiology remains uncertain. For paraclinical diagnosis, among the imaging investigations essential to support the diagnosis, CT angiography and MRI venography are reliable alternatives to digital subtraction angiography which represent the gold standard nowadays. In terms of treatment, international guidelines provide general directions for anticoagulation, with low molecular weight heparin being highly recommended. Regarding invasive treatment methods (thrombolysis, thrombectomy) that could be used in severe cases where anticoagulation has been shown to be insufficient, as well as symptomatic therapy, the evidence is often insufficient, new randomized clinical trials with large cohorts of patients being required.
... The use of elevated D-Dimer levels to evaluate severity of PE remains limited (6). D-Dimer age adapted cutoff level (D-Dimer cut off = age x 10 µg/l FEU,age > 50) defined categories of patients ≤50 and >50years of age (13,14). Although it is well recognized that PE has been shown to be major cause of mortality in younger population, there are relatively few studies looking particularly at PE in this age group (15).The aim of this study is to determine age-specifically role of D-Dimer in both age groups in patients with PE. ...
In patients with pulmonary embolism (PE), the D-Dimer assay is commonly utilized as part of the diagnostic workup, but data on D-Dimer for early risk stratification and short-term mortality prediction are limited. The purpose of this study was to determine D-Dimer levels as a predictive biomarker of PE outcomes in younger (<50 years of age) compared to older patients. We conducted retrospective analysis for 930 patients diagnosed with PE between 2015 and 2019 as part of the Serbian University Multicenter Pulmonary Embolism Registry (SUPER).All patients had D-Dimer levels measured within 24 hours of hospital admission. The primary outcome was mortality at 30 days or during hospitalization. Patients were categorized into two groups based on age (≤ 50 and >50 years of age). Younger patients constituted 20.5% of the study cohort. Regarding all-cause mortality, 5.2% (10/191)of patients died in group under the 50 years of age; the short-term all-causemortality was 12.4% (92/739) in older group.We have found that there was significant difference in plasma D-Dimer level between patients ≤ 50 years of age and older group (>50), p= 0.006.D-Dimer plasma level had good predictive value for the primary outcome in younger patients (c-statistics 0.710; 95% CI, 0.640-0.773; p<0.031). The optimal cutoff level for D-Dimer to predict PE-cause death in patients aged > 50 years was found to be 8.8 mg/l FEU(c-statistics 0,580; 95% CI 0.544-0.616; p=0.049). In younger PE patients, D-Dimer levels have good prognostic performance for 30-day all-cause mortalityand concentrations above 6.3 mg/l FEU are associated with increased risk of death. D-Dimer in patients aged over 50 years does not have predictive ability for all-caused short-term mortality. The relationship between D-Dimer and age in patients with PE may need further evaluation.
... Some studies showed that the use of age-adjusted Ddimer cut-off in the diagnostic strategy for the specificity and sensitivity of deep vein thrombosis is more valuable over 50 years old [7,8]. Nybo and Hvas argued that the use of an age-adjusted D-dimer in patients above 50 years of age for ruling out DVT seems as safe as using a standard D-dimer cut-off [9]. ...
Purpose
To compare the specificity and sensitivity of preoperative D-dimer and age-adjusted D-dimer value for predicting the incidence of the DVT preoperatively in total joint arthroplasty (TJA) patients.
Methods
We enrolled 406 patients finally above 50 years old. Everyone had done ultrasonography bedside, and D-dimer concentrations were collected before surgery. The D-dimer and age-adjusted D-dimer cut-off was calculated by multiple logistic regression and receiver operating curve (ROC) analyses.
Results
A total of 39 patients had found asymptomatic deep vein thrombosis (DVT) by ultrasonography. The age (odds ratio [OR] 1.067; p = 0.003) and D-dimer (OR 1.331; p = 0.025) were related to the existence of DVT. For conventional D-dimer and age-adjusted D-dimer value, the area under the curves (AUCs) were 0.685 (0.499–0.696) and 0.795 (0.611–0.881), respectively.
Conclusion
Compared to traditional D-dimer, age-adjusted D-dimer showed better performance in screening DVT, which was useful clinically.
... Each variables is strongly associated with DVT in trauma patients. It has previously [23] been described that the D-dimer could further improve both the speci city and the positive predictive value based on age-adjusted cutoff values; therefore, it is not surprising that this was incorporated into our predictive model. The risk factor of ISS has been validated as an independent risk factor for DVT diagnosis, and the incidence of DVT signi cantly increases with increasing ISS trauma score [24]. ...
Background: Trauma patients have an increased risk of deep vein thrombosis (DVT). Early identification of patients with a high risk of DVT after trauma is crucial for thromboembolism prophylaxis. We aimed to develop and prospectively validate a novel risk score based on a nomogram to predict lower extremity DVT among trauma patients.
Methods: Clinical data were collected from 281 trauma patients who were admitted to our trauma center within 24 h of admission from September 2016 to January 2019 to develop a novel DVT risk score. The DVT risk estimates were then calculated prospectively based on the score in a new study cohort from February 2019 to July 2020. The technique of least absolute shrinkage and selection operator (LASSO) was used to select variables for the early prediction of DVT in trauma patients. The DVT risk assessment score (DRAS) was constructed by incorporating related features based on the LASSO analysis and nomogram prediction model. Further, the trauma patients were divided into various risk groups according to the DRAS. The incidence of lower extremity DVT was compared between groups and the discrimination of the DRAS was assessed using the area under the curve (AUC).
Results: Based on the LASSO method, eight variables (age, injury severity score, body mass index, D-dimer level, fibrin degradation products, prothrombin time, prealbumin level, and hemoglobin level) were included in the DRAS. A total of 166 trauma patients were enrolled in this prospective study. Increased risk of DVT after trauma was related to higher DRAS. The area under the receiver operating characteristic (ROC) curve for the DRAS was 0.890(0.840–0.939) in the validation cohort. Moreover, the discriminatory capacity of the DRAS was superior to that of each variable independently and the Modified Wells score (P<0.05).
Conclusions: We developed and prospectively validated the DRAS to predict the risk of lower extremity DVT among trauma patients, which may facilitate early identification of high-risk patients.
... Diagnostic test results such as sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer levels in this study were consistent with a study by Junxun Li et al. which found that the sensitivity of D dimer levels was higher than 16 the specificity. These results indicated that the measurement of plasma D-dimer levels to Doppler ultrasound could be used as a screening test. ...
It is reported the incidence of DVT is approximately 84 cases per 100,000 each year, with 30-50% of untreated DVT are atrisk for pulmonary embolism, causing a 12% increase in mortality rate. An accurate and rapid diagnosis of DVT is needed tominimize the risk of complications and prevent unnecessary anticoagulant therapy without waiting for the results of adiagnostic examination using ultrasound. This study aimed to determine the diagnostic value of plasma D-dimer levels onDoppler ultrasound for DVT diagnosis to help clinicians to select a rapid and accurate diagnostic test for DVT diagnosis. Thisresearch was a retrospective study using data from medical records and performed at the Medical Record Installation of Dr.Wahidin Sudirohusodo Hospital, Makassar, by taking data on patients with DVT along with the results of D-dimer andDoppler ultrasound from January to December 2018. D-dimer levels were measured using an immunoturbidimetric methodwith a reference value of<0.5 μg/mL. A total of 33 samples were obtained with a mean of D-dimer value was higher inpositive Doppler (5.29) compared to negative (2.31), although not statistically significant (p> 0.05). Also, the mean of Wellsscore was higher in positive Doppler (4.74) compared to negative (4.17), although not statistically significant (p> 0.05). Thediagnostic values of D-dimer were as follows: sensitivity of 92.6%, specificity of 33.3%, positive predictive value of 86.2%,negative predictive value of 50.0%, and accuracy of 81.8%. D-dimer test can be used both for screening and diagnostic testswith cut-off value ≥ 2 μg/mL.
D‐dimer (DD) and ultrasonography (US) are part of the diagnostic workup for lower‐extremity deep vein thrombosis (DVT). Recent studies have shown that adjusting DD level cut‐offs by age or clinical pre‐test probability (PTP) decreases the use of US. We compared diagnostic accuracy of PTP‐adjusted DD and age‐adjusted DD in 3883 patients (F: 61.1%; age: 65.3 ± 16.8 y) referred to our unit for clinically suspected DVT. All patients underwent clinical evaluation, DD, and US. Proximal DVT was detected in 477 (12.4%) patients, and distal DVT was isolated in 342 (8.9%) patients. In the remaining 3064 patients there were 23 venous thromboembolic events (0.75%, 95% CI: 0.50–1.12) during the 3‐month follow‐up. The specificities of DD, age‐adjusted DD, and PTP‐adjusted DD in patients without high PTP levels were 47% (95% CI: 45–49), 61% (95% CI: 59–62), and 67% (95% CI: 65–68), respectively. The negative predictive value (NPV) was 96% (95% CI: 95–97) for all diagnostic strategies. When only proximal DVTs were considered, the NPV increased to 99% (95% CI: 98–99). US was avoided in 37% (95% CI: 36–38) of patients with a fixed cut‐off DD, 48% (95% CI: 47–50) with age‐adjusted DD, and 52% (95% CI: 51–54) with PTP‐adjusted DD. The failure rate for all DVTs of DD, age‐adjusted DD, and PTP‐adjusted DD was 2.0% (95% CI: 1.6–2.5), 2.7% (95% CI: 2.2–3.2), and 2.5% (95% CI: 2.1–3.0), respectively. Compared with the standard DD cut‐off, both age‐adjusted and PTP‐adjusted DD reduced the proportion of patients who required US at the cost of a small increase in failure rate.
Update
This article was updated on June 17, 2022 because of a previous error. On page 33, in the section entitled “17 - Does administration of tranexamic acid (TXA) to patients undergoing orthopaedic procedures increase the risk of subsequent VTE?”, and in the note on page 161, the name “Armin Arish” now reads “Armin Arshi.”
An erratum has been published: J Bone Joint Surg Am. 2022 Aug 3;104(15):e69.
