TY  - BOOK
AU  - Damodaram, M.
AU  - Kaladindi, M.
AU  - Luckit, J.
AU  - Yoong, W.
TI  - D-dimers as a screening test for venous thromboembolism in pregnancy: is it of any use?
SN  - 01443615
PY  - 2009///
N1  - NMUH Staff Publications; 29
N2  - <span style="font-size: 10pt;"><span style="line-height: 17.999801635742188px;">In non-pregnant women, </span><span class="highlight" style="line-height: 17.999801635742188px;">D-dimers</span><span style="line-height: 17.999801635742188px;"> are used successfully to aid </span><span class="highlight" style="line-height: 17.999801635742188px;">diagnosis</span><span style="line-height: 17.999801635742188px;"> of suspected pulmonary embolus (PE), as they have high sensitivity, moderate specificity and high negative predictive value. However, D-dimer levels are physiologically raised in </span><span class="highlight" style="line-height: 17.999801635742188px;">pregnancy</span><span style="line-height: 17.999801635742188px;"> and thus overlap the values normally associated with PE. The aim of this retrospective study therefore was to investigate the use of D-dimer levels as a </span><span class="highlight" style="line-height: 17.999801635742188px;">screening</span><span style="line-height: 17.999801635742188px;"> </span><span class="highlight" style="line-height: 17.999801635742188px;">test</span><span style="line-height: 17.999801635742188px;"> for suspected PE in </span><span class="highlight" style="line-height: 17.999801635742188px;">pregnancy</span><span style="line-height: 17.999801635742188px;"> and to determine if a negative D-dimer level could exclude the </span><span class="highlight" style="line-height: 17.999801635742188px;">diagnosis</span><span style="line-height: 17.999801635742188px;"> in pregnant women. A total of 37 women suspected of PE had both ventilation perfusion (VQ) scans and D-dimer levels performed. Thirteen were reported as having a low probability of PE following VQ scan, while 24 were thought to have a moderate or high probability of PE. Women who had a low probability of PE following VQ scanning were found to have D-dimer levels ranging from 0.25-2.2 mg/l, while women who had a high probability of PE following scanning had D-dimer levels ranging from 0.31-1.74 mg/l. The sensitivity and specificity of D-dimer as a </span><span class="highlight" style="line-height: 17.999801635742188px;">test</span><span style="line-height: 17.999801635742188px;"> for suspected PE in </span><span class="highlight" style="line-height: 17.999801635742188px;">pregnancy</span><span style="line-height: 17.999801635742188px;"> was calculated to be 0.73 and 0.15 respectively, while the negative likelihood ratio was 1.8. Current guidelines advocate the use of a negative D-dimer result to exclude the </span><span class="highlight" style="line-height: 17.999801635742188px;">diagnosis</span><span style="line-height: 17.999801635742188px;"> of PE in </span><span class="highlight" style="line-height: 17.999801635742188px;">pregnancy</span><span style="line-height: 17.999801635742188px;">. However, this study suggests that D-dimer testing in </span><span class="highlight" style="line-height: 17.999801635742188px;">pregnancy</span><span style="line-height: 17.999801635742188px;"> has a high negative likelihood ratio and should not be used. Larger prospective observational studies are required to collaborate the findings from this study.</span></span&gt
UR  - http://www.ncbi.nlm.nih.gov/pubmed/19274539
UR  - http://informahealthcare.com/doi/pdf/10.1080/01443610802649045
ER  -