Can causes of false-normal D-dimer test [SimpliRED®] results be identified?

R. A. Kraaijenhagen, J. Wallis, M. M W Koopman, M. R. De Groot, F. Piovella, P. Prandoni, H. R. Büller

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: To simplify the diagnostic strategy of patients suspected for venous thromboembolism, the use of D-dimer tests has been advocated. Very important for the safety of such diagnostic strategies would be the capacity to recognise false-normal D-dimer results, in order to prevent inadequately withholding anticoagulant treatment in patients who actually have the disease. Insight in the causes of false-normal D-dimer results would therefore be necessary. We hypothesised that certain patient characteristics are associated with relatively low plasma D-dimer levels and, therefore, could increase the risk of false-normal results. Methods: Consecutive patients with an objectively confirmed venous thromboembolic event and an independently obtained false-normal SimpliRED D-dimer test result were included in the study. For each patient, two controls with objectively confirmed venous thromboembolism and an adequate abnormal D-dimer result were selected. Baseline patient characteristics, obtained by standardised questionnaires, were compared between the two groups of patients. Results: In total, 686 patients had a venous thromboembolic event and 47 of these patients had a false-normal SimpliRED result. Therefore, the overall sensitivity of the SimpliRED test for venous thromboembolism was 94% (95% CI: 92-95%). Although the prevalence of certain clinical characteristics was significantly higher in patients with a false-normal D-dimer result than in the controls [odds ratios for (LMW)heparin treatment and symptoms lasting more than 10 days: 5.1 (95% CI: 1.5-18.7) and 3. 2 (95% CI:1.4-7.4), respectively], the prevalence of these characteristics was also high in the control group with an adequate abnormal D-dimer. Combining two or more of these characteristics had a low prevalence and did not further improve the ability to identify those patients with a false-normal D-dimer test at presentation. Conclusions: Although these findings clearly indicate an association between certain baseline clinical characteristics and the occurrence of a false-normal SimpliRED test, the clinical utility for these characteristics is limited.

Original languageEnglish
Pages (from-to)155-158
Number of pages4
JournalThrombosis Research
Volume111
Issue number3
DOIs
Publication statusPublished - 2003

Fingerprint

Venous Thromboembolism
fibrin fragment D
Withholding Treatment
Anticoagulants
Heparin
Odds Ratio
Safety
Control Groups
Therapeutics

Keywords

  • Accuracy
  • D-dimer
  • Diagnosis
  • Negative predictive value
  • Pulmonary embolism
  • Sensitivity
  • Thromboembolism
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Hematology

Cite this

Kraaijenhagen, R. A., Wallis, J., Koopman, M. M. W., De Groot, M. R., Piovella, F., Prandoni, P., & Büller, H. R. (2003). Can causes of false-normal D-dimer test [SimpliRED®] results be identified? Thrombosis Research, 111(3), 155-158. https://doi.org/10.1016/j.thromres.2003.08.028

Can causes of false-normal D-dimer test [SimpliRED®] results be identified? / Kraaijenhagen, R. A.; Wallis, J.; Koopman, M. M W; De Groot, M. R.; Piovella, F.; Prandoni, P.; Büller, H. R.

In: Thrombosis Research, Vol. 111, No. 3, 2003, p. 155-158.

Research output: Contribution to journalArticle

Kraaijenhagen, RA, Wallis, J, Koopman, MMW, De Groot, MR, Piovella, F, Prandoni, P & Büller, HR 2003, 'Can causes of false-normal D-dimer test [SimpliRED®] results be identified?', Thrombosis Research, vol. 111, no. 3, pp. 155-158. https://doi.org/10.1016/j.thromres.2003.08.028
Kraaijenhagen, R. A. ; Wallis, J. ; Koopman, M. M W ; De Groot, M. R. ; Piovella, F. ; Prandoni, P. ; Büller, H. R. / Can causes of false-normal D-dimer test [SimpliRED®] results be identified?. In: Thrombosis Research. 2003 ; Vol. 111, No. 3. pp. 155-158.
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abstract = "Background: To simplify the diagnostic strategy of patients suspected for venous thromboembolism, the use of D-dimer tests has been advocated. Very important for the safety of such diagnostic strategies would be the capacity to recognise false-normal D-dimer results, in order to prevent inadequately withholding anticoagulant treatment in patients who actually have the disease. Insight in the causes of false-normal D-dimer results would therefore be necessary. We hypothesised that certain patient characteristics are associated with relatively low plasma D-dimer levels and, therefore, could increase the risk of false-normal results. Methods: Consecutive patients with an objectively confirmed venous thromboembolic event and an independently obtained false-normal SimpliRED D-dimer test result were included in the study. For each patient, two controls with objectively confirmed venous thromboembolism and an adequate abnormal D-dimer result were selected. Baseline patient characteristics, obtained by standardised questionnaires, were compared between the two groups of patients. Results: In total, 686 patients had a venous thromboembolic event and 47 of these patients had a false-normal SimpliRED result. Therefore, the overall sensitivity of the SimpliRED test for venous thromboembolism was 94{\%} (95{\%} CI: 92-95{\%}). Although the prevalence of certain clinical characteristics was significantly higher in patients with a false-normal D-dimer result than in the controls [odds ratios for (LMW)heparin treatment and symptoms lasting more than 10 days: 5.1 (95{\%} CI: 1.5-18.7) and 3. 2 (95{\%} CI:1.4-7.4), respectively], the prevalence of these characteristics was also high in the control group with an adequate abnormal D-dimer. Combining two or more of these characteristics had a low prevalence and did not further improve the ability to identify those patients with a false-normal D-dimer test at presentation. Conclusions: Although these findings clearly indicate an association between certain baseline clinical characteristics and the occurrence of a false-normal SimpliRED test, the clinical utility for these characteristics is limited.",
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AU - De Groot, M. R.

AU - Piovella, F.

AU - Prandoni, P.

AU - Büller, H. R.

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N2 - Background: To simplify the diagnostic strategy of patients suspected for venous thromboembolism, the use of D-dimer tests has been advocated. Very important for the safety of such diagnostic strategies would be the capacity to recognise false-normal D-dimer results, in order to prevent inadequately withholding anticoagulant treatment in patients who actually have the disease. Insight in the causes of false-normal D-dimer results would therefore be necessary. We hypothesised that certain patient characteristics are associated with relatively low plasma D-dimer levels and, therefore, could increase the risk of false-normal results. Methods: Consecutive patients with an objectively confirmed venous thromboembolic event and an independently obtained false-normal SimpliRED D-dimer test result were included in the study. For each patient, two controls with objectively confirmed venous thromboembolism and an adequate abnormal D-dimer result were selected. Baseline patient characteristics, obtained by standardised questionnaires, were compared between the two groups of patients. Results: In total, 686 patients had a venous thromboembolic event and 47 of these patients had a false-normal SimpliRED result. Therefore, the overall sensitivity of the SimpliRED test for venous thromboembolism was 94% (95% CI: 92-95%). Although the prevalence of certain clinical characteristics was significantly higher in patients with a false-normal D-dimer result than in the controls [odds ratios for (LMW)heparin treatment and symptoms lasting more than 10 days: 5.1 (95% CI: 1.5-18.7) and 3. 2 (95% CI:1.4-7.4), respectively], the prevalence of these characteristics was also high in the control group with an adequate abnormal D-dimer. Combining two or more of these characteristics had a low prevalence and did not further improve the ability to identify those patients with a false-normal D-dimer test at presentation. Conclusions: Although these findings clearly indicate an association between certain baseline clinical characteristics and the occurrence of a false-normal SimpliRED test, the clinical utility for these characteristics is limited.

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KW - Accuracy

KW - D-dimer

KW - Diagnosis

KW - Negative predictive value

KW - Pulmonary embolism

KW - Sensitivity

KW - Thromboembolism

KW - Thrombosis

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