OCT 12, 2018 08:00 AM PDT

Clinical Use of D-dimer in Venous Thromboembolism

C.E. CREDITS: P.A.C.E. CE | Florida CE
Speakers
  • Professor of Medicine, UNC-Chapel Hill Hemophilia & Thrombosis Center
    Biography
      Dr. Moll received his medical degree from Freiburg University, Germany, He completed an internship/residency in internal medicine and a hematology-oncology fellowship at Duke University Medical Center (1989-1996), during which he also did a 1-year clinical coagulation fellowship at the University of North Carolina, Chapel Hill (1994-1995). Dr. Moll's postgraduate career included a position in clinical coagulation in the cardiology division of the Humboldt University in Berlin, Germany (1997-1999). Dr. Moll has been a faculty member at UNC in the Department of Medicine and the Division of Hematology-Oncology since 1999. His clinical focus is coagulation, particularly thrombosis and thrombophilia. Dr. Moll's research interests include clinical trials on new anticoagulants, better use of established anticoagulants, antiphospholipid antibody syndrome and postthrombotic syndrome. He has a major interest in health education of patients, public and health care providers about blood clots and clotting disorders. Since 2001 he has written a Q/A section on thrombosis and thrombophilia for the non-profit website www.fvleiden.org. Dr. Moll is a co-founder of the national patient advocacy group NBCA (National Blood Clot Alliance; www.stoptheclot.org), and a board member of the national non-profit anticoagulation provider organization AC-Forum (Anticoagulation Forum; www.acforum.org). He has authored and coauthored a number of peer-reviewed articles textbook chapters on blood clots. He is the founder of the UNC Blood Clot Education Outreach Program created in 2010.

    Abstract:

                                     

                                                             
     

    D-dimer can be a useful tool in the management of patients with suspected or established venous thromboembolism (VTE). One use is in the assessment of a patient who presents with symptoms of VTE. First, a pre-test probability assessment with a validated scoring system, such as the Wells’ score, is performed by the clinician. Based on the absence or presence of a number of symptoms and signs of VTE and the presence of VTE risk factors, a patient is considered to be at low or high risk for VTE. In the low risk group, a D-dimer can then be performed. A negative result rules out VTE, making further imaging studies (e.g. venous Doppler ultrasound or chest CT scan) unnecessary. The second use of the D-dimer test is as a tool when determining the length of anticoagulation therapy necessary in a patient who has had a VTE. In patients with unprovoked or estrogen-associated VTE, a negative D-dimer – on or off anticoagulation - predicts a lower risk of recurrence, whereas a positive D-dimer predicts a higher risk. D-dimer has been incorporated into several decision tools for assessing length of anticoagulation, such as the HERDOO-2 score, the DASH-score, and the Vienna-score.

    Learning Objectives:

    • Discuss how D-dimer is used by clinicians in conjunction with a clinical pre-test probability assessment in the evaluation of a patient who presents with symptoms leading to suspicion of deep vein thrombosis (DVT) or pulmonary embolism (PE)
    • List several of the components of the Wells’ score for the pretest probability assessment of DVT and PE
    • Discuss how  D-dimer is used by clinicians to determine length of anticoagulation in patients with DVT or PE
    • Discuss the risk-of-VTE-recurrence triangle and VTE recurrence risk assessment tools (e.g. HERDOO-2 score, DASH-score, Vienna score) available to clinicians for determining how long a patient should be treated with anticoagulation

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