D-dimer level for ruling out peripherally inserted central catheter-associated upper extremity deep vein thrombosis and superficial vein thrombosis.
Wanli Liu, Lianxiang He, Wenjing Zeng and 5 others
PMID 34399039WHAT IT FOUND
A negative D-dimer did not reliably exclude PICC-associated upper extremity vein thrombosis.
Among 180 low-risk patients with negative D-dimer, 39 had thrombosis on ultrasound.
Key findings
01A negative D-dimer did not rule out PICC-associated venous thrombosis: 39 of 180 low-Wells patients with negative D-dimer had thrombosis on ultrasound, a failure rate of 21.7%.
02For PICC-associated upper extremity vein thrombosis, D-dimer sensitivity was 51.9%, specificity was 70.5%, and negative predictive value was 78.3%.
03The negative predictive value was 91.0% for superficial vein thrombosis and 84.9% for deep vein thrombosis, and it was 80.0% in cancer patients and 60.0% in non-cancer patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-centre retrospective study, so the results may not apply to other hospitals or patient groups. Patients were included only if they had both D-dimer testing and ultrasound, and many PICC patients were excluded because they did not have these tests. The hospital did not have a systematic ultrasound screening protocol, so the true number of thrombosis cases may have been underestimated. The analysis included only patients with a modified Wells score below 2, so it does not show what happens in higher-risk patients. Follow-up after extubation was not analysed. Possible diagnostic bias from clinicians choosing ultrasound was not evaluated. The authors noted that further analysis in non-cancer patients was not conducted.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that a negative D-dimer can replace ultrasound in patients with a PICC and a low Wells score. Thirty-nine of 180 patients with a negative D-dimer had thrombosis on ultrasound, and the negative predictive value was 78.3%.