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Thromb Haemost 2005; 93(05): 982-988
DOI: 10.1160/TH04-11-0734
New Technologies and Diagnostic Tools
Schattauer GmbH

Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries

A multicentre clinical outcome study
Antoine Elias
1   Departments of Vascular Medicine
,
Alain Cazanave
1   Departments of Vascular Medicine
,
Marie Elias
1   Departments of Vascular Medicine
,
Valérie Chabbert
2   Radiology, Rangueil University Hospital Centre, Toulouse, France
,
Henri Juchet
3   Emergency, Rangueil University Hospital Centre, Toulouse, France
,
Hélène Paradis
7   Department of Cardiology and Vascular Medicine, General Hospital Centre, Auch, France
,
Philippe Carrière
8   Department of Cardiology and Vascular Medicine, General Hospital Centre, Rodez, France
,
Françoise Nguyen
4   Haemostasis, Rangueil University Hospital Centre, Toulouse, France
,
Alain Didier
5   Pulmonology, Rangueil University Hospital Centre, Toulouse, France
,
Michel Galinier
6   Cardiology, Rangueil University Hospital Centre, Toulouse, France
,
Cyrille Colin
9   Department of Medical Information of the Hospices Civils de Lyon, Lyons, France
,
Dominique Lauque
3   Emergency, Rangueil University Hospital Centre, Toulouse, France
,
Francis Joffre
2   Radiology, Rangueil University Hospital Centre, Toulouse, France
,
Hervé Rousseau
2   Radiology, Rangueil University Hospital Centre, Toulouse, France
› Author AffiliationsFinancial support: The study was supported by a grant from Laboratoires Bio Mérieux, Marcy l’Etoile, France. The study was sponsored by the University Hospital of Toulouse for regulatory and ethic submission.
Further Information

Publication History

Received 13 November 2004

Accepted after revision 07 February 2005

Publication Date:
11 December 2017 (online)

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Summary

The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1–3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.

Keywords

Pulmonary embolism - D-dimer - ultrasound / diagnosis - helical computed tomography - clinical / epidemiological studies
 

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