Abstract
Objectives
There is growing evidence that venous thromboembolism (VTE) patients with distal clots
(distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE])
may not routinely benefit from anticoagulation. We compared the D-dimer levels in
VTE patients with distal and proximal clots.
Methods
We conducted a multinational, prospective observational study of low-to-intermediate
risk adult patients presenting to the emergency department (ED) with suspected VTE.
Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal
DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate
analyses.
Results
Of 1752 patients with suspected DVT, 1561 (89.1%) had no DVT, 78 (4.4%) had a distal
calf DVT, and 113 (6.4%) had a proximal DVT. DVT patients with proximal clots had
higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and
negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL
were 40.7% and 52.1% respectively. Of 1834 patients with suspected PE, 1726 (94.1%)
had no PE, 7 (0.4%) had isolated sub-segmental PE, and 101 (5.5%) had non-sub-segmental
PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL)
than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer
cutoff of 3499 mg/dL were 57.4% and 10.4% respectively.
Conclusions
VTE patients with proximal clots had higher D-dimer levels than patients with distal
clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients
with distal or proximal clots.
Keywords
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Article Info
Publication History
Published online: April 20, 2018
Accepted:
April 19,
2018
Received in revised form:
April 18,
2018
Received:
March 2,
2018
Footnotes
☆Supported by Siemens Healthcare Diagnostics, Newark, DE.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
