Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;16(2):427-429.
doi: 10.1007/s12265-022-10306-0. Epub 2022 Aug 30.

Clinical Utility of D-Dimer for Rule-Out or Rule-In of Venous Thromboembolism in Syncope

Patrick Badertscher #  1   2 , Jeanne du Fay de Lavallaz #  3   4 , Angelika Hammerer-Lercher  5 , Christian Mueller  3   4 ; BASEL IX Investigators
Collaborators, Affiliations

Clinical Utility of D-Dimer for Rule-Out or Rule-In of Venous Thromboembolism in Syncope

Patrick Badertscher et al. J Cardiovasc Transl Res. 2023 Apr.

Abstract

Fig. 1 Diagnostic performance of D-dimer using two different assays in patients presenting with syncope. A Left: Receiver-operating characteristic curves quantifying the diagnostic performance of Innovance® D-dimer (blue) and hs-Loci-Innovance® D-dimer (red) for the diagnosis of venous thromboembolism (VTE). Right: Clinical application of D-dimer using the 2-level Wells-score with age-adjusted1 or fixed cutoffs versus the YEARS-algorithm with probability-adjusted cut offs2. B Left: Specificity for different cufoffs of Innovance® D-dimer (blue) and hs-Loci-Innovance® D-dimer (red) for the diagnosis of venous thromboembolism (VTE). Right: Percentage of patients ruled-in and correctly identified VTE patients for different cutoffs of Innovance® D-dimer (blue) and hs-Loci-Innovance® D-dimer (red). 1In patients 50 years or younger, D-dimer concentration < 0.5 mg/l was considered negative. For patients older than 50 years, we used the formula: age in years divided by 100. 2YEARS-algorithm: assessment of only three items from the Wells-score (clinical signs of deep vein thrombosis, hemoptysis, pulmonary embolism the most likely diagnosis) and using a D-dimer test threshold of 0.5 mg/l in presence, and 1.0 mg/l in absence of one of the YEARS-items.

Keywords: Diagnostic testing; Pulmonary embolism; Syncope.

PubMed Disclaimer

Conflict of interest statement

The authors designed the study, gathered and analyzed the data, vouch for the data and analysis, wrote the paper, and decided to publish. Drs. Badertscher, du Fay de Lavallaz, and Mueller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the manuscript. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the manuscript. The manuscript and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible web sites or e-print servers. Professor Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the KTI, Abbott, Beckman Coulter, BRAHMS, Idorsia, Novartis, Quidel, Roche, Siemens, and Singulex, as well as speaker/consulting honoraria from Amgen, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Idorsia, Novartis, Osler, Roche, and Sanofi. Dr. Badertscher has received research funding from the “University of Basel,” the “Stiftung für Herzschrittmacher und Elektrophysiologie,” and the “Freiwillige Akademische Gesellschaft Basel.” PD Dr. Hammerer-Lercher has received speaker honoraria from Abbott and Beckman Coulter outside the submitted work. All other authors declare that they have no conflict of interest with this study.

References

    1. Badertscher P, du Fay de Lavallaz J, Hammerer-Lercher A, Nestelberger T, Zimmermann T, Geiger M, et al. Prevalence of pulmonary embolism in patients with syncope. J Am Coll Cardiol [Internet]. Journal of the American College of Cardiology; 2019 [cited 2019 Sep 26];74:744–54. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109719356104 - PubMed
    1. Verma AA, Masoom H, Rawal S, Guo Y, Razak F. Pulmonary embolism and deep venous thrombosis in patients hospitalized with syncope: a multicenter cross-sectional study in Toronto, Ontario, Canada [Internet]. JAMA Intern. Med. American Medical Association; 2017 [cited 2018 May 28]. page 1046–8. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2... - PMC - PubMed
    1. Costantino G, Ruwald MH, Quinn J, Camargo CA, Dalgaard F, Gislason G, et al. Prevalence of pulmonary embolism in patients with syncope. JAMA Intern Med [Internet]. American Medical Association; 2018 [cited 2018 May 28];178:356–62. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2... - PMC - PubMed
    1. Konstantinides SV, Meyer G, Bueno H, Galié N, Gibbs JSR, Ageno W, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) Eur Heart J. 2020;41:543–603. doi: 10.1093/eurheartj/ehz405. - DOI - PubMed
    1. Farm M, Siddiqui AJ, Onelöv L, Järnberg I, Eintrei J, Maskovic F, et al. Age-adjusted D-dimer cut-off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays. J Thromb Haemost [Internet]. 2018 [cited 2018 Aug 3];16:866–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29505695 - PubMed

Publication types

Substances