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Clinical Assessment and D-dimer Testing in Deep Venous Thrombosis
- Clive Kearon, MB, PhD; and
- Jeffrey S. Ginsberg, MD
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IN RESPONSE:
Dr. Wakai is concerned that other clinical centers, and particularly emergency departments, may have difficulty replicating the results of our study. We believe that the two limitations he discusses, which are common to most diagnostic tests, are interrelated and can be readily overcome. In contrast to other D-dimer assays, the assay we used in our study, SimpliRED (AGEN Biomedical, Ltd., Brisbane, Australia), can be performed at the bedside on a fingerstick sample and yields a result within minutes. At our institution, a nurse or a technician with previous training performs the test; we estimate that it takes about 2 hours of training to learn how to perform and interpret it. Alternatively, the SimpliRED assay can be performed in the laboratory on an anticoagulated venous blood sample (1). Regardless of where and on what type of sample the test is performed, the interpretation of presence (positive result) or absence (negative result) of red cell agglutination is subjective. Although interobserver agreement has been reported to be excellent (2), this may not always be the case; subjective errors of interpretation are probably responsible for the high false-negative rate of this test for venous thromboembolism reported by some investigators (3).
Provided that diagnostic accuracy is not sacrificed and that there is a short “turnaround time,” we agree with Dr. Wakai about the advantage of an objective D-dimer test. Rapid enzyme-linked immunosorbent assays (4) and novel microparticle latex-based tests (5) seem to satisfy these requirements. However, compared with SimpliRED, the equipment required to perform these assays is substantial. Regardless of the type of D-dimer assay used, staff training and ongoing quality control of test performance will be required.
Clive Kearon, MB, PhD
Jeffrey S. Ginsberg, MD
McMaster University
Hamilton, Ontario L8V 1C3, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
