Evaluation of a D-Dimer Protocol for Detection of Venous Thromboembolism.

Abstract

BACKGROUND:

The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism.

METHODS:

We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE.

RESULTS:

In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 μg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 μg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 μg/mL during hospitalization were independent predictors of VTE.

CONCLUSIONS:

The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 μg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.

• Authors: Michael Karsy, Mohammed A Azab, Jonathan Harper, Hussam Abou-Al-Shaar, Jian Guan, Ilyas Eli, Andrea A Brock, Ryan D Ormond, Patrick W Hosokawa, Ramkiran Gouripeddi, Ryan Butcher, Chad D Cole, Sarah T Menacho, William T Couldwell
• Journal: World neurosurgery (World Neurosurg) Vol. 133 Pg. e774-e783 (Jan 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 31605841 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• Adult
• Aged
• Biomarkers (blood)
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Sensitivity and Specificity
• Venous Thromboembolism (blood, diagnosis)
• Venous Thrombosis (blood)