----- Original Message -----
From: "Dunn Matthew Dr. ACCIDENT & EMERGENCY - SwarkHosp-TR"
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To: <[log in to unmask]>
Sent: Wednesday, October 17, 2001 10:24 AM
Subject: Re: D-dimers
> > A quick straw poll. How many people use D-dimers as
> > screening test for DVT & PE?
> >
> > Thanks,
> > Fred Cartwright.
We use the D-Dimer on all patients who present with suspected DVT as part of
a risk assessment strategy. The patient are treated along an agreed
clinical pathway using the following:
All patients will have a Venogram/Ultrasound if the D-Dimer is positive.
Those with a negative D-Dimer will have Venometry(Stain Gauge
Plethysmography) initially and only if this is positive will they proceed to
have USS/Venogram. These tests are all performed in the radiology department
and are not available out of hours or during the weekends.
In those who have a positive D-Dimer but a negative Ultrasound (Venogram
not performed or unsuccessful) it might be argued strongly that they
require a repeat Usscan at a week.. According to 'Bernardi F, Prandoni P,
Lensing AWA et al, D-Dimer testing as adjunct with clinically suspected deep
vein thrombosis: Prospective cohort study.BMJ1998 317;1037-40', there were 5
patients out of 88 (5.7%) in whom repeat ultrasound were abnormal at a week.
Three other patients attended with suspected PEs within three months and was
confirmed in two. In all 7 patients tested positive(8%) for a DVT/PE even
after a negative scan when D-Dimer was positive compared to one patient in
598(0.015%) in whom both were negative.
What is the list stance on these patients? Do you routinely rescan at a
week?
Thanks
Salim Shubber
SpR A&E
Belfast
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