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Predictive value of D-dimer testing for the diagnosis of venous thrombosis in unusual locations: A systematic review.

Authors
  • Ordieres-Ortega, L1
  • Demelo-Rodríguez, P2
  • Galeano-Valle, F3
  • Kremers, B M M4
  • Ten Cate-Hoek, A J4
  • Ten Cate, H4
  • 1 Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain. , (Spain)
  • 2 Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Institute of Sanitary Research (IISGM), Madrid, Spain. Electronic address: [email protected] , (Spain)
  • 3 Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Institute of Sanitary Research (IISGM), Madrid, Spain. , (Spain)
  • 4 Department of Internal Medicine, Laboratory of Clinical Thrombosis and Hemostasis, and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands. , (Netherlands)
Type
Published Article
Journal
Thrombosis research
Publication Date
Feb 15, 2020
Volume
189
Pages
5–12
Identifiers
DOI: 10.1016/j.thromres.2020.02.009
PMID: 32126379
Source
Medline
Language
English
License
Unknown

Abstract

The value of D-dimer testing for the diagnosis of thrombosis in unusual sites is not properly established and evidence is scarce. We performed a systematic review of the literature. The search was conducted in MEDLINE and Cochrane Library for papers published in the last 10 years including different presentations of thrombosis in unusual sites. Twenty-three articles were included, from January 1, 2008, to December 31, 2018, comprising 3378 patients with thrombosis in unusual sites (upper extremity deep vein thrombosis, cerebral vein thrombosis and splanchnic vein thrombosis). The Newcastle-Ottawa scale was used to assess the quality of the studies. Two articles were related to upper extremity thrombosis, showing a high sensitivity and negative predictive value for D-dimer testing. Twelve articles concerned cerebral vein thrombosis, concluding that the timing of D-dimer testing was important, and that patients with a shorter duration of symptoms showed higher D-dimer levels. Sensitivity and specificity in these patients ranged from 58% to 97% and from 77% to 97.5%, respectively. Nine articles were related to splanchnic vein thrombosis. One described a population of patients with mesenteric venous thrombosis, and the rest included patients with portal vein thrombosis. The D-dimer testing methods and the proposed cut-off levels were remarkably different among the included studies. D-dimer testing should not be currently recommended for the diagnosis of thrombosis in unusual sites as a first line diagnostic tool. The development of algorithms combining biomarkers such as D-dimer and clinical decision tools could improve the diagnosis. Copyright © 2020 Elsevier Ltd. All rights reserved.

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