Wee-Shian Chan, MD, MSc; Jeffrey S. Ginsberg, MD
Potential Financial Conflicts of Interest: None disclosed.
Chan W, Ginsberg JS. d-Dimer Testing in Pregnancy: Clinically Useful, but at What Cost?. Ann Intern Med. 2008;148:484-485. doi: 10.7326/0003-4819-148-6-200803180-00021
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Published: Ann Intern Med. 2008;148(6):484-485.
Drs. Lippi and Montagnana raise 2 important issues about our study of pregnant women with suspected DVT: The low specificity and positive predictive value of the d-dimer test (SimpliRED) and the relatively small number of patients with DVT (n = 13) in our cohort result in wide 95% CIs associated with the sensitivity and negative predictive value of the test.
We agree that the positive predictive value is far too low to conclude that an abnormal test result is diagnostic of DVT. The purpose of our study was to show that this d-dimer assay is sensitive and therefore has high negative predictive value, and that the specificity is sufficiently high to make the test useful. On the basis of the results, we concluded that a normal d-dimer test result can be used to exclude the diagnosis of DVT in pregnant women.
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