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Saturday, December 7, 2013
Bleeding and Clotting Disorders
I work in a Cardiovascular Lab and recently have found that multiple doctors in the hospital have been more reliant on D-dimer tests to justify a lower extremity venous study. The problem with this is that there have been many unnecessary tests ordered, a lot of which do not any other symptoms (such as pain and/or swelling) other than an elevated d-dimer. I have recently started logging such tests and the results, and as of yet, I have NEVER had any positive test for which an elevated d-dimer was the sole reason for an exam. How accurate are d-dimer tests and what can cause a false-positive result?
The d-dimer assay is reasonably repeatable, but as pointed out, the question is should one order it routinely. We only order it in working up patients for DIC or if a pulmonary embolus or dvt is suspected. It is not used as a screening test since we see it elevated without good reasons.
Eric H Kraut, MD
Professor of Hematology
College of Medicine
The Ohio State University