What is the efficacy of D-dimer testing in the workup of deep venous thrombosis (DVT)?

Updated: Jun 06, 2019
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Current evidence strongly supports the use of a D-dimer assay in the setting of suspected DVT. Most studies have confirmed the clinical utility of D-dimer testing, and most clinical algorithms incorporate its use. The D-dimer assay has a high sensitivity (up to 97%); however, it has a relatively poor specificity (as low as 35%) [105] and therefore should only be used to rule out DVT, not to confirm the diagnosis of DVT.

A negative D-dimer assay result rules out DVT in patients with low-to-moderate risk (Wells DVT score <2). (See Risk Stratification.) A negative result also obviates surveillance and serial testing in patients with moderate-to-high risk and negative ultrasonographic findings. All patients with a positive D-dimer assay result and all patients with a moderate-to-high risk of DVT (Wells DVT score >2) require a diagnostic study (duplex ultrasonography).

Studies indicate that the D-dimer test can be used as a rapid screening measure in cases where leg swelling exists in the face of equivocal or negative clinical or radiologic findings. Forty percent of patients with a negative clinical examination and negative D-dimer test require no further clinical evaluation. Similarly, subjects with an elevated D-dimer test at 1 month following anticoagulant cessation have a significantly higher risk of recurrent venous thromboembolism (VTE). [106]


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