Article
General practitioners’ use of D-dimer in venous thrombo-embolic events: cohort study in one geographical region in The Netherlands
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Published: | September 5, 2017 |
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Background: Diagnosing thrombo-embolic events (VTE) -deep vein trombosis (DVT) and pulmonary embolism (PE)- is a challenge in general practice. Combining a D-dimer test and clinical-decision rule is advocated, yet robust and accurate D-dimer point-of-care tests (POCTs) are not yet available. The actual use of routine laboratory D-dimer testing by general practitioners (GPs) might provide useful insights into the necessity and practical implementation of a future D-dimer POCT.
Question: How many GP-referred VTEs are diagnosed during one year in one geographical region and what was the role of laboratory D-dimer testing in those referred with suspicion of VTE?
Method: We analysed all patients -in a region with approximately 150,000 inhabitants- in whom either the GP determined a D-dimer value and/or who had a diagnostic work-up for suspected VTE in a non-academic hospital in 2015.
Results: A total of 148 DVTs and PEs were diagnosed in hospital. GPs urgently referred 470 patients to secondary care, of which 31.3% had a VTE. Of those referred based on clinical assessment only 73.8% (96/130) had a DVT or PE and after D-dimer testing 15.5% (51/340). GPs requested 821 laboratory D-dimer tests. Applying age-adjusted cut-off values in patients ≥50 years, decreased the number of abnormal D-dimer values with 18.5%, without missing any VTE.
Discussion: GPs have a high detection rate for VTE in patients directly referred to secondary care. Although the D-dimer test contributes significantly to the diagnostic work-up of VTE, the implementation of a D-dimer POCT in family practice needs careful consideration, as GPs infrequently use D-dimer in daily practice.