Study Objective: To determine the clinical usefulness of D-dimer ELISA test in elderly patients with clinically suspected pulmonary embolism (PE). Design: Prospective cohort study. Patients: Ninety-six consecutive outpatients older than 70 years with a duration of symptoms shorter than one week and without metastatic cancer or recent surgery, trauma, infection, stroke, myocardial infarction, deep vein thrombosis (DVT) or PE, or treatment with curative doses of heparin or oral anticoagulant. Intervention: All patients underwent at least ventilation/perfusion scan and bilateral ultrasonic duplex scan and a blood sample collection within 24 hours of admission. When necessary a pulmonary angiography and/or a bilateral venography were also performed. Patients were classified as follows: (1) PE-positive; positive angiography or high probability V/Q scan and deep vein thrombosis (proven either by venography or by ultrasonic duplex scan) or non high probability V/Q scan and either DVT (proven at presentation by venography or by ultrasonic duplex scan) or symptomatic thromboembolic event within 3 months of follow-up; or (2) PE-negative; normal V/Q scan or normal angiography or non high probability V/Q scan and either negative ultrasonic duplex scan or normal venography and low clinical probability and absence of symptomatic thromboembolism within 3 months of follow-up. D-dimer measurements were performed using both a conventional and a single semi-quantitative ELISA test (Asserachrom D-di, Instant I.A.D-dimer). Results: Using a cutoff value of 500 ng/ml, the conventional ELISA D-dimer test showed a sensitivity and a negative predictive value of 100% with poor specificity and positive predictive value of 14.3% and 45.5% respectively. The new rapid semi-quantitative D-dimer test displays worse results with sensitivity, negative predictive value, specificity and positive predictive value of 92.3%, 82.4%, 25% and 46% respectively. Conclusion: In a geriatric population, conventional ELISA D-dimer is a good marker to exclude PE but, due to the comorbid conditions, only a few patients presented with D-dimer values less than 500 ng/ml.
References
1
Kinasewitz GT.
Thrombophlebitis and pulmonary embolism in the elderly patient.. Clinics in Chest Medicine 1993; 3: 523-36.
3
The Prospective Investigation Of Pulmonary Embolism Diagnosis (PIOPED) Investigators..
Value of the ventilation-perfusion scan in acute pulmonary embolism: resultats of the prospective investigation of pulmonary embolism diagnosis Investigators.. JAMA 1990; 263: 2753-9.
4
Bounameaux H,
de Moerloose P,
Perrier A,
Reber G.
Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview.. Thromb Haemost 1994; 71: 1-6.
7
Perrier A,
Bounameaux H,
Morabia A,
De Moerloose P,
Slosman D,
Didier D,
Unger PF,
Junod A.
Diagnosis of pulmonary embolism by a decision analysis based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study.. Arch Intern Med 1996; 156: 531-6.
8
Cadroy Y,
Pierrejean D,
Fontan B,
Sié P,
Boneu B.
Influence of aging on the activity of the hemostatis system: prothrombin fragment 1+2, thrombin-antithrombin III complexes and D-dimers in 80 healthy subjects with age ranging from 20 to 94 years.. Nouv Rev Fr Hematol 1992; 34: 43-6.
9
Kniffin WD,
Baron JA,
Barrett J,
Birkmeyer JD,
Anderson FA.
The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.. Arch Intern Med 1994; 154: 861-6.
11
Vissac AM,
Grimau M,
Chartier S,
Chan FA,
Chambrette B,
Amiral J.
A new sensitive membrane based Elisa technique for instantaneous D-dimer evaluation in emergency.. Thromb Res 1995; 78: 314-52.
12
Ginsberg JS,
Wells PS,
Brill-Edwards P,
Donovan D,
Panju A,
Van Beek EJR,
Patel A.
Application of a novel and rapid Whole blood assay for D-dimer in patients with clinically suspected pulmonary embolism.. Thromb Haemost 1995; 73: 35-8.
13
Veilt M,
Hamwi A,
Kurtaran A,
Virgolini I,
Vukovich T.
Comparison of four rapid D-dimer tests for diagnosis of pulmonary embolism.. Thromb Research 1996; 82: 399-407.
15
De Moerloose P,
Vissac AM,
Reber G,
Bounameaux H,
Amiral J.
A new, semi-quantitative and individual elisa assay for rapid measurment of plasma D-dimer in patients suspected of venous thromboembolism.. Thromb Haemost. 1995 73. abstract 760.
16
Bailliart O,
Benedlhadj S,
Kedra A,
Duet M,
Dupuy E,
Zini JM,
Elkharat D,
Jaillet N,
Mouliade C,
Drouet L,
Soria C,
Mundler O.
A new D-dimer assay appropriate in emergency: its interest for the exclusion of recent deep vein thrombosis or pulmonary embolism.. Haemostasis. 1996 26. abstract 312.
17
Bailliart O,
Soria C,
Kedra A,
Duet M,
Benelhadj S,
Dupuy E,
Zini JM,
Jaillet N,
Mouliade C,
Vissac AM,
Amiral J,
Drouet L,
Mundler O.
The use of a new D-dimer assay, Instant I. A., is suitable for emergency diagnosis of deep vein thrombosis or pulmonary embolism.. Thromb Haemost. 1995 73. abstract 756.
