A Comparative Analysis of D-Dimer Assays in Patients with Clinically Suspected Pulmonary Embolism

Edwin J R van Beek; Bram van den Ende; René J Berckmans; Yvonne T van der Heide; Dees P M Brandjes; Augueste Sturk; Jan W ten Cate

doi:10.1055/s-0038-1649595

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1993; 70(03): 408-413
DOI: 10.1055/s-0038-1649595

Original Article

Clinical Studies

Schattauer GmbH Stuttgart

A Comparative Analysis of D-Dimer Assays in Patients with Clinically Suspected Pulmonary Embolism

Edwin J R van Beek

¹The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

,

Bram van den Ende

²The Department of Clinical Chemistry, Slotervaart Hospital, Amsterdam, The Netherlands

,

René J Berckmans

¹The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

,

Yvonne T van der Heide

²The Department of Clinical Chemistry, Slotervaart Hospital, Amsterdam, The Netherlands

,

Dees P M Brandjes

¹The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

³The Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands

,

Augueste Sturk

¹The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

,

Jan W ten Cate

¹The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

› Author Affiliations

Abstract

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Summary

To avoid angiography in patients with clinically suspected pulmonary embolism and non-diagnostic lung scan results, the use of D-dimer has been advocated. We assessed plasma samples of 151 consecutive patients with clinically suspected pulmonary embolism. Lung scan results were: normal (43), high probability (48) and non-diagnostic (60; angiography performed in 43; 12 pulmonary emboli). Reproducibility, cut-off values, specificity, and percentage of patients in whom angiography could be avoided (with sensitivity 100%) were determined for two latex and four ELISA assays.

The latex methods (cut-off 500 μg/1) agreed with corresponding ELISA tests in 83% (15% normal latex, abnormal ELISA) and 81% (7% normal latex, abnormal ELISA). ELISA methods showed considerable within- (2–17%) and between-assay Variation (12–26%). Cut-off values were 25 μg/l (Behring), 50 μg/l (Agen), 300 μg/l (Stago) and 550 μg/l (Organon). Specificity was 14–38%; in 4–15% of patients angiography could be avoided.

We conclude that latex D-dimer assays appear not useful, whereas ELISA methods may be of limited value in the exclusion of pulmonary embolism.

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References

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