Title
A thrombin generation assay may reduce the need for compression ultrasonography for the exclusion of deep venous thrombosis in the elderly
Author
Haas, F.J.L.M.
Schutgens, R.E.G.
Kluft, C.
Biesma, D.H.
Publication year
2011
Abstract
Introduction. The exclusion of deep venous thrombosis (DVT) by pre-test probability (PTP) and D-dimer in the elderly is safe, but has a low specificity. There is increasing interest in the diagnostic role of thrombin generation in patients with thrombosis. We evaluated the value of thrombin generation in the exclusion of DVT, especially in elderly patients. Material and methods. All thrombin generation parameters of the Endogenous Thrombin Potential assay were tested retrospectively in a cohort of 443 patients suspected for DVT. The performance of the assay was calculated as AUC of the ROC curve and association with DVT as odds ratio (OR). The lag time value was combined with results of PTP and Innovance D-dimer assay. Results. All thrombin generation parameters had a low AUC. In the 4th age quartile, the corrected OR of lag time increased to 16 and the AUC of lag time for the combination PTP < 2 and D-dimers ≥ 500 μg/L was 0.96 with a cut-off value of 23.0 sec. The exclusion of DVT in patients ≥ 75 years (n 30), based on this combination and lag time values ≤ 23.0 sec had a NPV of 100% and a specificity of 96.0% in this subgroup of patients and decreased the number needed to test from 10 to 1.1. Conclusion. Thrombin generation parameters alone are inappropriate for the exclusion of DVT. However, in the elderly, the current algorithm of exclusion of DVT may improve markedly by the addition of the lag time results of the ETP. © 2011 Informa Healthcare.
Subject
Life
MHR - Metabolic Health Research
EELS - Earth, Environmental and Life Sciences
Health
Clinical prediction rule
D-dimer
Diagnosis management
Elderly
Thrombin generation
Venous thrombosis
Clinical prediction rule
D-dimer
Diagnosis management
Elderly
Thrombin generation
Venous thrombosis
D dimer
thrombin
aged
article
clinical assessment tool
clinical evaluation
d dimer assay
deep vein thrombosis
diagnostic accuracy
diagnostic value
differential diagnosis
disease association
echography
endogenous thrombin potential assay
human
intermethod comparison
major clinical study
pre test probability
priority journal
sensitivity and specificity
thrombin time
thrombin, 869858-13-9, 9002-04-4
To reference this document use:
http://resolver.tudelft.nl/uuid:e32f4e0e-56d2-410b-b321-6ab38ff7253a
DOI
https://doi.org/10.3109/00365513.2010.534173
TNO identifier
426801
ISSN
0036-5513
Source
Scandinavian Journal of Clinical and Laboratory Investigation, 71 (1), 12-18
Document type
article