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D-dimer assay guidelines: value of objective testing for VTE in the emergency setting

Lack of formal international standardisation of tests for venous thromboembolism means that appropriate medical care may sometimes not be given. Here, Laurence Loï looks at the current situation.

Venous thromboembolism (VTE) is a dangerous and potentially fatal medical condition accounting for approximately 25,000 deaths annually in the UK alone. It cannot be diagnosed solely on the basis of clinical presentation due to the lack of sensitivity and specificity of signs and symptoms.The high-sensitivity, automated D-dimer laboratory assay plays a critical role in the diagnostic algorithm (Fig 1) that clinicians use for the exclusion of VTE in the emergency situations.

            Currently, there is still no formal international standard, resulting in various assays with different cut-offs and clinical performances. Efforts to standardise D-dimer results have not proved successful because the D-dimer analyte – a marker of endogenous fibrinolysis – is not consistent across the different assays.

            To help clinicians and laboratories improve diagnosis strategies and patient care, several internationally respected organisations, such as the Clinical and Laboratory Standards Institute (CLSI), have published more stringent guidelines. A key aspect focuses on the need for objective laboratory testing as clinical assessment alone is often unreliable. Emergency clinicians need to have a robust D-dimer result to enable them to implement the appropriate medical care. It is also important to avoid unnecessary anticoagulant therapy, which carries its own risks.

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Upcoming Events

USCAP 113th Annual Meeting

Baltimore Convention Center, Baltimore, Maryland, USA
23-28 March, 2024

Pathology Horizons 2024

MacDonald Bath Spa Hotel, Bath
18-20 April, 2024

Diagnostics North East Conference 2024

The Catalyst, Newcastle upon Tyne
19 April, 2024

ECCMID 2024 - European Congress of Clinical Microbiology and Infectious Diseases

Fira Gran Via, 08038 Barcelona, Spain
27-30 April 2024

British Society for Microbial Technology Annual Microbiology Conference

UK Health Security Agency, Colindale, London
2 May 2024

EQA Reports: Interpreting Key Information & Troubleshooting Tips

ONLINE - Zoom
Thursday 16th May 2024

Access the latest issue of Pathology In Practice on your mobile device together with an archive of back issues.

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