gms | German Medical Science

51. Kongress für Allgemeinmedizin und Familienmedizin

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)

21.09. - 23.09.2017, Düsseldorf

General practitioners’ use of D-dimer in venous thrombo-embolic events: cohort study in one geographical region in The Netherlands

Meeting Abstract

  • A. Schols - Maastricht University, Maastricht, Niederlande
  • E. Meijs - Maastricht University, Maastricht, Niederlande
  • G. Dinant - Maastricht University, Maastricht, Niederlande
  • M. Krekels - Zuyderland Medical Centre, Sittard, Niederlande
  • J. Cals - Maastricht University, Maastricht, Niederlande

51. Kongress für Allgemeinmedizin und Familienmedizin. Düsseldorf, 21.-23.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17degam157

doi: 10.3205/17degam157, urn:nbn:de:0183-17degam1572

Published: September 5, 2017

© 2017 Schols et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.