D-dimer for PICC associated UEDVT diagnosis
Abstract:
Objectives: Deep vein thrombosis in the upper extremities caused by peripherally placed central catheters is distinct from typical deep vein thrombosis. This specific kind of mural thrombus may have an impact on D-dimer levels. This study aimed to ascertain if the level of D-dimer level might be considered as independent separate diagnostic marker to rule out upper extremity deep vein thrombosis caused by peripherally implanted central catheters.
Methods: This case cohort study was done in the past. Two hundred and five patients who experienced D-dimer measurement and color Doppler ultrasound within 14 days after the insertion of a peripheral central catheter to December 31, 2020 from January 1, 2018 participated in the research. The participants were followed up for 3 months for upper extremity deep vein thrombosis. Different D-dimer diagnostic strategies were analyzed.
Results: Out of 205 included patients, 53 (25.9%) hold a negative D-dimer; 10 of the 53 patients had upper extremity deep vein thrombosis attributable to peripherally implanted central catheters using color Doppler ultrasound, of which 3 patients developed upper extremity deep vein thrombosis during 3-month follow-up. With various D-dimer diagnostic techniques, 81.1% was the negative predictive value of the levels of D-dimer.
Conclusions: The outcome of this study shows that the different D-dimer diagnostic strategies are not effective for safely excluding the diagnosis of suspected peripherally inserted central catheter-related upper extremity deep vein thrombosis. Adding “peripherally inserted central catheter line insertion” as a special factor in modified Wells score along with the level of D-dimer could securely remove peripherally inserted central catheter-related upper extremity deep vein thrombosis, but diagnostic efficacy is low.
Reference:
Liu W, He L, Zhou J, Zeng W, Zeng S, Gong Z. Different Diagnostic Strategies Using D-dimer for Peripherally Inserted Central Catheter- Related Upper Extremity Deep Vein Thrombosis. J Vasc Surg Venous Lymphat Disord. 2023 Jan 18:S2213-333X(23)00005-7. doi: 10.1016/j.jvsv.2022.07.018. Epub ahead of print. PMID: 36681296.