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The evaluation of D-dimers in venous thromboembolism (VTE) and pulmonary embolism (PE)


D-dimer is a specific marker for identifying fibrin degradation. It is also an indirect marker of hypercoagulability. Its high values ​​can be seen in a wide variety of diseases associated with activation of coagulation and fibrinolysis, such as: disseminated intravascular coagulation (CID), arterial disease, venous thrombosis, pulmonary thromboembolism and inflammatory processes. Current quantitative assays for D-dimer determination are very sensitive, but are not specific for the identification of venous thromboembolism. A series of studies have shown a high negative predictive value of the quantitative results of D-dimer. Currently, this laboratory test is used to exclude VTE.

Diagnostic algorithms of pulmonary embolism usually involve a clinical probability score combined with pulmonary imaging techniques (eg pulmonary perfusion scintigraphy). A high diagnostic probability, resulting from pulmonary imaging, associated with a high or intermediate clinical probability, results in a positive diagnosis of PE. All other combinations, between pulmonary imaging and clinical probability require further investigation, as occurs in about 50% of patients with clinical suspicion of PE.

From the clinical laboratory perspective, current tests for D-dimer determination are easy to accomplish, including Point of Care analysers. Numerous publications have highlighted that D-dimer determination implies high sensitivity and high negative predictive value.

The D-dimer evaluation test, developed by Radiometer / Denmark, is easy and quick to perform and is suitable for emergency testing. This whole blood analysis is fully automated and can be done with the AQT90 FLEX analyser, which allows you to get results in about 20 minutes.

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