D-dimer plasma concentration in various clinical conditions: implication for the use of this test in the diagnostic approach of venous thromboembolism.

Plasma measurement of D-Dimer (DD) represents a definite aid in the diagnostic approach of outpatients with suspected venous thromboembolism (VTE). However, the high sensitivity (about 95%) of the test which allows to rule out VTE when concentrations are below a given cutoff (500 micrograms/L as measured by the ELISA technique) is counterbalanced by a poor specificity (about 40%). Because the specificity might even be lower in patients who are hospitalized we determined the DD plasma concentration in 255 patients who were consecutively admitted in general internal medicine wards with various pathological conditions. The proportion of patients who had DD levels below the cutoff of 500 micrograms/L was 6% (1/18) in patients with VTE and 22% (52/237) in hospitalized patients without VTE: the figure was 21% in patients with pulmonary infections, 14% in patients with other infections, 11% in patients with neoplastic diseases, 34% in patients with coronary or cerebrovascular disease, 19% in patients with cardiac failure, 69% in patients with rheumatologic disease and in 16% in subjects with miscellaneous clinical conditions. The high rate of elevated plasma DD in hospitalized patients questions the usefulness of this test in the diagnostic approach of VTE in aged patients who present with concomitant disease like infections, neoplasia, cardiac failure and many other pathological conditions, except rheumatologic affections and coronary or cerebrovascular diseases.