Browsing by Subject "Deep vein thrombosis"

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    Guidance for the treatment and prevention of obstetric-associated venous thromboembolism.
    (J Thromb Thrombolysis, 2016-01) Bates, Shannon M; Middeldorp, Saskia; Rodger, Marc; James, Andra H; Greer, Ian
    Venous thromboembolism (VTE), which may manifest as pulmonary embolism (PE) or deep vein thrombosis (DVT), is a serious and potentially fatal condition. Treatment and prevention of obstetric-related VTE is complicated by the need to consider fetal, as well as maternal, wellbeing when making management decisions. Although absolute VTE rates in this population are low, obstetric-associated VTE is an important cause of maternal morbidity and mortality. This manuscript, initiated by the Anticoagulation Forum, provides practical clinical guidance on the prevention and treatment of obstetric-associated VTE based on existing guidelines and consensus expert opinion based on available literature where guidelines are lacking.
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    International, multicenter evaluation of a new D-dimer assay for the exclusion of venous thromboembolism using standard and age-adjusted cut-offs.
    (Thrombosis research, 2018-04-05) Parry, Blair Alden; Chang, Anna Marie; Schellong, Sebastian M; House, Stacey L; Fermann, Gregory J; Deadmon, Erin K; Giordano, Nicholas J; Chang, Yuchiao; Cohen, Jason; Robak, Nancy; Singer, Adam J; Mulrow, Mary; Reibling, Ellen T; Francis, Samuel; Griffin, S Michelle; Prochaska, Jürgen H; Davis, Barbara; McNelis, Patricia; Delgado, Joao; Kümpers, Philipp; Werner, Nikos; Gentile, Nina T; Zeserson, Eli; Wild, Philipp S; Limkakeng, Alexander T; Walters, Elizabeth Lea; LoVecchio, Frank; Theodoro, Daniel; Hollander, Judd E; Kabrhel, Christopher
    We sought to determine the test characteristics of an automated INNOVANCE D-dimer assay for the exclusion of pulmonary embolism (PE) and deep venous thrombosis (DVT) in emergency department (ED) patients using standard and age-adjusted cut-offs.Cross-sectional, international, multicenter study of consecutive patients with suspected DVT or PE in 24 centers (18 USA, 6 Europe). Evaluated patients had low or intermediate Wells PE or DVT scores. For the standard cut-off, a D-dimer result <500 ng/ml was negative. For the age adjusted cut-off, we used the formula: Age (years) ∗ 10. The diagnostic standard was imaging demonstrating PE or DVT within 3 months. We calculated test characteristics using standard methods. We also explored modifications of the age adjustment multiplier.We included 3837 patients and excluded 251. The mean age of patients evaluated for PE (n = 1834) was 48 ± 16 years, with 676 (37%) male, and 1081 (59%) white. The mean age of evaluated for DVT (n = 1752) was 53 ± 16 years, with 710 (41%) male, and 1172 (67%) white. D-dimer test characteristics for PE were: sensitivity 98.0%, specificity 55.4%, negative predictive value (NPV) 99.8%, positive predictive value (PPV) 11.4%, and for DVT were: sensitivity 92.0%, specificity 44.8%, NPV 98.8%, PPV 10.3%. Age adjustment increased specificity (59.6% [PE], 51.1% [DVT]), but increasing the age-adjustment multiplier decreased sensitivity without increasing specificity.INNOVANCE D-dimer is highly sensitive and can exclude PE and DVT in ED patients with low- and intermediate- pre-test probability. Age-adjustment increases specificity, without increasing false negatives.