PB0371 - The utility of D-dimer in excluding the diagnosis of proximal deep vein thrombosis in the anticoagulated population

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

EG

Elisabeth Gagnon

Internist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
Iv

Isabelle viens

Internist
Hôpital Ste-Croix / Université de Sherbrooke
Sherbrooke, Quebec, Canada
SK

Shaima Kaka

PGY2 Internal Medicine
University of Ottawa
Ottawa, Ontario, Canada
AC

Anjellica Chen

PGY3 Internal Medicine
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
CL

Cassandra Larivière

PGY4 Internal Medicine
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
MA

Mathieu Allard

PGY4 Internal Medicine
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
AL

Anne-Audrey Lapointe

PGY4 Internal Medicine
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
ML

Marc-Alexandre Lavoie

Internist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
PP

Pierre-Nicolas Perron

Internist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
GL

Geneviève Le Templier

Internist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
DT

Dominique Toupin

Hematologist Oncologist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
EB

Etienne Beaudoin

Internist
Hopital Charles-Lemoyne
Longueuil, Quebec, Canada
MM

Mandy Malick

PhD
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
Gregoire Le Gal

Hematologist
University of Ottawa
Ottawa, Ontario, Canada

Presenting Author(s)

BG

Bobby Gouin, MD

Internist
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada

Background: The use of plasma D-dimer level to exclude lower-limb proximal deep vein thrombosis (pDVT) of low-intermediate risk non-anticoagulated patients has been well studied. However, its use for patients on chronic direct-acting oral anticoagulant (DOAC) therapy is unclear.

Aims: We aimed to evaluate D-dimer performance for the exclusion of pDVT among patients on DOACs who presented to the emergency department (ED) and underwent lower-limb compression ultrasound for clinically suspected DVT.

Methods: Patients aged ≥ 18 years on DOAC therapy who presented to the ED between September 2019 and January 2023 and had, in one visit (or in two visits within two days), a plasma D-dimer measurement and a lower-limb compression ultrasound to assess DVT were included. The primary outcome was to evaluate the diagnostic accuracy of a negative D-dimer in the exclusion of a new pDVT.

Results: Our study included 40 patients. Three patients (7,5%) had a new diagnosis of pDVT, of which two had active cancer. The sensitivity of abnormal conventional or age adjusted D-dimer thresholds to detect pDVT in this population was 100.0% (95%CI 29,2-100.0) for both thresholds, whilst the negative predictive value to exclude pDVT in this population was 100.0% (95%CI 54,1-100.0 and 75,3-100.0 respectively for each D-dimer threshold).

Conclusion(s): In patients on chronic DOAC therapy, plasma D-dimer level appears to have a high sensitivity and a high negative predictive value. This study suggests a possible role of plasma D-dimer level in the exclusion of PE among patients on DOAC therapy with a clinical suspicion of PE. However, these findings are hypothesis-generating only, and further studies are required.

We are conducting the same study in a second tertiary hospital to include more patients, and results should be available for the ISTH 2024 congress.