小柯机器人

加拿大麦克马斯特大学Sameer Parpia团队研究了根据临床概率校正D-二聚体诊断深静脉血栓形成的效果。相关论文于2022年2月15日发表在《英国医学杂志》上。

为了评估基于临床预试验概率的D-二聚体阈值排除深静脉血栓形成（DVT）诊断算法的安全性和有效性，研究组在加拿大的大学急诊或门诊进行了一项前瞻性诊断管理研究。招募有深静脉血栓症状或体征的患者，若Wells低临床预试验概率和D-二聚体<1000 ng/mL，或Wells中等临床预试验概率和D-二聚体<500 ng/mL，则无需进一步检查即可排除DVT。

所有其他患者均进行了近端超声成像。重复近端超声检查仅限于最初超声检查阴性、低或中等临床预试验概率、D-二聚体>3000 ng/mL，或高临床预试验概率和D-二聚体>1500 ng/mL的患者。如果没有诊断出DVT，则患者无需接受抗凝治疗。主要观察指标为三个月时有症状的静脉血栓栓塞。

共有1508例患者入组并进行分析，其中173例（11.5%）在定期诊断试验中出现DVT。在未接受抗凝治疗的1275名按计划检测的无近端DVT患者中，有8名（0.6%）在随访期间发现静脉血栓栓塞。与传统的DVT检测策略相比，这种诊断方法将对超声检查的需求从每位患者平均1.36次扫描减少到0.72次，相对减少47%。

研究结果表明，这种结合临床预试验概率和D-二聚体的诊断策略，在随访期间可确定DVT风险较低的患者，同时大大减少了超声成像的需要。

附：英文原文

Title: Diagnosis of deep vein thrombosis with D-dimer adjusted to clinical probability: prospective diagnostic management study

Author: Clive Kearon, Kerstin de Wit, Sameer Parpia, Sam Schulman, Frederick A Spencer, Sangita Sharma, Marc Afilalo, Susan R Kahn, Gregoire Le Gal, Sudeep Shivakumar, Shannon M Bates, Cynthia Wu, Alejandro Lazo-Langner, Frédérick DAragon, Jean-Franois Deshaies, Luciana Spadafora, Jim A Julian

Issue&Volume: 2022/02/15

Abstract:

Objective To evaluate the safety and efficiency of a diagnostic algorithm for deep vein thrombosis (DVT) that uses clinical pretest probability based D-dimer thresholds to exclude DVT.

Design Prospective diagnostic management study.

Setting University based emergency departments or outpatient clinics in Canada.

Participants Patients with symptoms or signs of DVT.

Intervention DVT was considered excluded without further testing by Wells low clinical pretest probability and D-dimer <1000 ng/mL or Wells moderate clinical pretest probability and D-dimer <500 ng/mL. All other patients had proximal ultrasound imaging. Repeat proximal ultrasonography was restricted to patients with initially negative ultrasonography, low or moderate clinical pretest probability, and D-dimer >3000 ng/mL or high clinical pretest probability and D-dimer >1500 ng/mL. If DVT was not diagnosed, patients did not receive anticoagulant treatment.

Main outcome measure Symptomatic venous thromboembolism at three months.

Results 1508 patients were enrolled and analysed, of whom 173 (11.5%) had DVT on scheduled diagnostic testing. Of the 1275 patients with no proximal DVT on scheduled testing who did not receive anticoagulant treatment, eight (0.6%, 95% confidence interval 0.3% to 1.2%) were found to have venous thromboembolism during follow-up. Compared with a traditional DVT testing strategy, this diagnostic approach reduced the need for ultrasonography from a mean of 1.36 scans/patient to 0.72 scans/patient (difference 0.64, 95% confidence interval 0.68 to 0.60), corresponding to a relative reduction of 47%.

Conclusions The diagnostic strategy using a combination of clinical pretest probability and D-dimer identified a group of patients at low risk for DVT during follow-up while substantially reducing the need for ultrasound imaging.

DOI: 10.1136/bmj-2021-067378

Source: https://www.bmj.com/content/376/bmj-2021-067378

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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