D-dimer testing: advantages and limitations in emergency medicine for managing acute venous thromboembolism

Abstract

D-dimer values can be rapidly determined and used for the management of acute venous thromboembolism (VTE). However, its role in the setting of emergency still remains unclear and inappropriate testing is a significant clinical problem. This review discusses the currently used assays, clinical indications, and limitations of D-dimer measurement. Studies in English language were identified by searching PubMed from December 1985 to December 2005. Available literature on D-dimer was identified from Medline, along with cross referencing from the reference lists of major articles and reviews on this subject. Among 56 articles collected, 14 papers, 4 overviews and 1 systemic review were selected accordingly to predefined criteria. Data synthesis shows that D-dimer testing has sufficient diagnostic accuracy for ruling out acute VTE if used in combination with standardised clinical judgement. D-dimer seems to be also a useful tool for managing suspected VTE patients in absence of immediate imaging. Attention should be paid to exclude conditions that may affect the accuracy of the test, such as concomitant disease, heparin administration and symptom duration >15 days. Although enzyme-linked immunosorbent assay determination has the highest accuracy, immunoturbidimetric assay seems the most suitable on an emergency basis because of its rapid performance. In conclusion, at present D-dimer testing can be safely used in the management of acute VTE in emergency medicine. However, because of its heterogeneity related to the method used and setting implemented, it is preferable to assess D-dimer accuracy before its implementation in management strategies for VTE.