USEFULNESS OF MEASURING PLASMA D-DIMERS F OR DIAGNOSIS OF ACUTE VENOUS THROMBOEMBOLISM

The diagnostic usefulness of measuring plasma D-dimers using the ELISA method and the latex agglutination test has been prospectively evalua ted in 117 patients hospitalized for suspicion of acute venous thrombo -embolism (AVTE): pulmonary embolism was suspected in 80 patients and the remaining 37 had a suspicion of deep vein thrombosis of the lower limbs. The diagnosis of AVTE was confirmed in 50% of the patients, all of whom underwent gold standard invasive investigation i.e. pulmonary angiography and/or contrast venography. The sensitivity specificity n egative predictive value and positive predictive value of a D-dimers p lasma concentration exceeding 500 ng/ml for the diagnosis of AVTE were respectively 98, 58, 97 and 70% when using the ELISA method and 86, 7 1, 84 and 75% when using the latex assay. In 47 patients whose lung sc ans yielded abnormalities of indeterminate probability of pulmonary em bolism, the sensitivity of the ELISA method was very high (94%), but t hat of later assay was low (67%). Our results demonstrate that measuri ng rite plasma D-dimers by the latex assay should not be used in the d iagnosis of AVTE. On the other hand the ELISA method might be of great interest in the diagnostic strategy of AVTE, as a normal concentratio n of D-dimers rules out almost definitely the diagnosis of AVTE, and h ence, spares from performing invasive investigations.