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Les biomarqueurs en médecine d’urgence pp 259–275Cite as

D-dimères et diagnostic de la maladie thromboembolique veineuse

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Part of the book series: Références en médecine d’urgence. Collection de la SFMU ((REFERMED))

Résumé

Léutilisation des biomarqueurs dans le diagnostic de maladie thromboembolique veineuse est une histoire déjà ancienne et probablement une des meilleures illustrations de l’application des principes de Bayes dans le cadre d’une médecine basée sur des preuves. C’est dans les années 1980 que les D-dimères furent proposés comme un test d’exclusion de la thrombose veineuse profonde (TVP) puis de l’embolie pulmonaire (EP) [1, 2]. Ils ont depuis été largement étudiés en tant qu’outil diagnostique dans la maladie thrombo-embolique veineuse (MTEV) et sont intégrés, en association avec d’autres tests non ou peu invasifs (échographie- Doppler veineuse, angioscanner thoracique, scintigraphie…), dans les recommandations internationales sur la prise en charge d’une suspicion de MTEV [3, 4]. Le point marquant de ces tests diagnostiques, et les D-dimères n’y font pas exception, est qu’aucun ne permet d’exclure ou de confirmer le diagnostic de MTEV de façon absolue dans toutes les situations cliniques. L’interprétation du résultat va donc dépendre d’un paramètre fondamental : la probabilité clinique ou probabilité pré-test. Cette notion est connue sous le concept de Bayes où la décision diagnostique ne correspond pas à une certitude absolue mais à une démarche probabiliste s’appuyant sur une estimation du risque d’erreur.

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Author information

Authors and Affiliations

  1. Service des urgences adultes, Département de médecine d’urgence, Pôle 4, CHU Angers 4, rue Larrey, 49933, Angers Cedex 9, France

    P.-M. Roy & A. Penaloza

  2. faculté de médecine, L’UNAM Université, Angers, France

    P.-M. Roy & A. Penaloza

  3. Service des urgences, Cliniques universitaires St-Luc, Université catholique de Louvain, Belgique

    A. Penaloza

Authors
  1. P.-M. Roy
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  2. A. Penaloza
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Editors and Affiliations

  1. Département de médecine d’urgence, Centre hospitalier Princesse Grace, 1, avenue Pasteur, BP 489, MC-98012, Monaco

    Yann-Érick Claessens

  2. Hôpital Tenon Service d’accueil des urgences, UPMC-Paris 6, 4, rue de la Chine, 75020, Paris, France

    Patrick Ray

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Roy, PM., Penaloza, A. (2012). D-dimères et diagnostic de la maladie thromboembolique veineuse. In: Claessens, YÉ., Ray, P. (eds) Les biomarqueurs en médecine d’urgence. Références en médecine d’urgence. Collection de la SFMU. Springer, Paris. https://doi.org/10.1007/978-2-8178-0297-8_30

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  • DOI: https://doi.org/10.1007/978-2-8178-0297-8_30

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