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ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 45-58

The use of D-dimer in exclusion of diagnosis of suspected Deep Vein Thrombosis


1 Hemopathology, Senior Specialist Hemopathologist, Manager of Laboratory Department of Ibn Albitar Cardiac Specialized Center, Baghdad, Iraq
2 Cardiovascular Surgery, Senior Specialist Surgeon, Manager of Perfusion Department of Ibn Albitar Cardiac Specialized Center, Baghdad, IraqCardiovascular Surgery, Senior Specialist Surgeon, Manager of Perfusion Department of Ibn Albitar Cardiac Specialized Center, Baghdad, Iraq
3 Hemopathology, Senior Specialist Hemopathologist, Manager of Laboratory Department of Central Child Teaching, Baghdad, Iraq

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Background: Deep venous thrombosis is a common disorder associated with significant morbidity, chronic venous insufficiency as well as fatal pulmonary embolism. venography has been the gold standard of diagnosis, however it has been replaced in most areas by duplex ultrasound which is generally very good method .An interesting new approach to the diagnosis of DVT is D-dimer testing, D-dimer levels reflect the amount of lysed, crossed-linked fibrin and may be useful diagnostic marker in the clinically suspected DVT .D-dimer can be measured either quantitatively by ELISA or qualitatively by latex agglutination. Objectives: The aim of the study was to evaluate the use of D-dimer in exclusion of the diagnosis of DVT. Patient and methods: A total of 50 patients presented to vascular outpatient department with clinical suspicion of DVT have been studied ,patients with old DVT ,patients on anticoagulant, and patient with severe infection or inflammation were excluded .Venous duplex ultrasonography of the affected limb or limbs was done and citrated blood sample was analyzed for D-dimer by a VIDAS method for all patients blindly to the results of venous duplex .Sensitivity ,specificity, negative and positive predictive values were calculated .ROC curve then was generated from sensitivity and 1 _ specificity values at a continuum of D-dimer level to determine the optimal cut-off level of VIDAS D-dimer for exclusion of DVT. Results: The mean age of DVT group was 43 year. DVT was confirmed in 37 patients (74%), and excluded in 13 patients (26%) by venous duplex .The mean D-dimer level in the DVT group was 5498.021ng/dl while in non DVT group was 1906.384ng/dl this difference was statistically significant (P=0.0003). The sensitivity , specificity , negative and positive predictive values of VIDAS method at cut-off points(500 and 900) ng/dl were ( 100% , 33% , 100% , 82% ) respectively ,and at 3000ng/dl ( 71% ,75%, 47%,90% ) respectively Conclusions: VIDAS D-dimer method is a sensitive method that can be used in the initial management of deep vein thrombosis if a level of 900ng/dl is used as a cut-off point for exclusion of deep vein thrombosis. VIDAS D-dimer method is not a specific test so it cannot be used for the diagnosis of deep vein thrombosis.


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