D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis

Background: D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT). Aim: To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT. Study design: We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: <= 500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism. Results: We enrolled 239 patients (F: 63.6\%; mean +/- SD age: 58.3 +/- 16.8). At the initial diagnostic work-up, DVT was detected in 24 (10\%) patients while SVT in 35 (14.6\%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92\% (95\% CI: 73-99\%) and 60\% (95\% CI: 52-67\%) respectively, with a negative predictive value of 98\% (95\% CI: 93-100\%), whereas for SVT they were 77\% (95\% CI: 59-89\%) and 60\% (95\% CI: 52-67\%) respectively, with a negative predictive value of 93\% (95\% CI: 86-97\%). Conclusions: D-dimer has a negative predictive value >= 93\% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT. (C) 2015 Elsevier Ltd. All rights reserved.