PubMed · 10503375
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H Mitsuhashi, T Kinouchi. 1999. [Urinary FDP].. https://pubmed.ncbi.nlm.nih.gov/10503375/
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In recent years, a number of modalities have been evaluated for the diagnosis of venous thromboembolism. The role of these modalities is still evolving. While ventilation-perfusion scanning is important in the diagnosis of venous thromboembolism, spiral CT scanning, MRI, and D-dimer assays are now being used more often, either exclusively or in combination with ventilation-perfusion scanning. A number of diagnostic algorithms using these modalities are currently being evaluated. Regardless of which diagnostic approach is used, the clinician must be aware of some key limitations. Spiral CT scanning has gained popularity because it is noninvasive and can rapidly identify other cardiopulmonary diseases that mimic pulmonary embolism. Its use has been limited because of its inability to detect subsegmental pulmonary emboli. D-dimer assays offer promise as rapid, inexpensive screening tools. However, the wide variability in assay performance has limited its usefulness. We recommend that if D-dimer assays are to be used in a diagnostic algorithm, the clinician be aware of the details of the assay. At present, lack of data precludes use of MRI as a primary diagnostic tool for detection of venous thromboembolism.
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A diagnosis of recurrent venous thromboembolism is commonly suspected by physicians in the clinical setting. Many do not realize that recurrent venous thromboembolism may mimic the first venous thromboembolic event (VTE) and that only 20 to 30% of patients who have had a first VTE actually have objective recurrent thrombotic disease. Objective testing is necessary to prevent the misdiagnosis of thrombophilia in patients and the associated exposure to prolonged anticoagulant treatment that accompanies that diagnosis. In patients with clinically suspected recurrent venous thrombosis, compression ultrasonography in a new venous segment is the preferred diagnostic approach and contrast venography is an alternative test. There is insufficient evidence to know whether D-dimer testing is an effective approach to the diagnosis of thrombophilia. In patients with suspected recurrent pulmonary embolism, the diagnostic method should begin with ventilation/perfusion lung-imaging and a complementary pulmonary angiography when the results of initial tests are equivocal. Patients with recurrent venous thromboembolism should be treated with anticoagulants for longer than 6 months but the precise period depends on the patient's risk of bleeding as a result of the treatment. Finally, there is currently a lack of evidence that risk for recurrent VTE is increased in patients with a first episode of venous thromboembolism and heterozygous factor V Leiden mutation or the G2021OA prothrombin mutation.