Year 2022,
Volume: 4 Issue: 2, 58 - 62, 31.08.2022
Burak Kurtoğlu
,
Halil İbrahim Çıkrıklar
,
Vahide Aslıhan Durak
,
Issa Omar
,
Ahmet Münir Yılmaz
,
Sümeyye Tuğba Sarkı Cander
,
Erol Armagan
References
- 1. Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in context: D-Dimer. J Am Coll Cardiol 2017;70:2411-2420.
- 2. Keller K, Beule J, Balzer JO, Dippold W. D-Dimer and thrombus burden in acute pulmonary embolism. Am J Emerg Med 2018 ;36:1613-1618.
- 3. Bass AR, Fields KG, Goto R, Turissini G, Dey S, Russell LA. Clinical decision rules for pulmonary embolism in hospitalized patients: a systematic literature review and meta-analysis. Thromb Haemost 2017;117:2176-2185.
- 4. Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J 2003;20:319–325.
- 5. Geersing GJ, Janssen KJ, Oudega R, et al. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis. BMJ 2009;339:b2990.
- 6. Farm M, Siddiqui AJ, Onelöv L, et al. Age-adjusted D-dimer cut-off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays. J Thromb Haemost 2018;16:866-875.
- 7. Carrier M, Righini M, Djurabi RK, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies. Thromb Haemost 2009;101:886-892.
8. den Exter PL, van Es J, Klok FA, et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood 2013;122:1144-1149.
- 9. Kabrhel C, Mark Courtney D, Camargo CA Jr, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med 2010;17:589-597.
- 10. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014;311:1117-1124.
- 11. Lippi G, Bonfanti L, Saccenti C, Cervellin G. Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med 2014;25:45-48.
- 12. Akbaş SH, Can M, Kılıçarslan I, Özdem S, Çete Y, Gültekin M. Acil Servise Başvuran Yüksek D-dimer Düzeyli Hastalarda Tanı Dağılımı ve D-dimer Düzeylerinin Hastaneye Yatış ve Ölüm Oranları ile İlişkisi. Turk J Emerg Med 2004;4:149-154.
- 13. Falanga A, Russo L, Milesi V, Vignoli A. Mechanisms and risk factors of thrombosis in cancer. Crit Rev Oncol Hematol. 2017;118:79-83.
- 14. Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine 1999;78:285-291.
- 15. Wang S, Zimmermann S, Parikh K, Mansfield AS, Adjei AA. Current Diagnosis and Management of Small-Cell Lung Cancer. Mayo Clin Proc 2019 ;94:1599-1622.
- 16. Stein PD, Gottschalk A, Saltzman HA, Terrin ML. Diagnosis of acute pulmonary embolism in the elderly. J Am Coll Cardiol 1991 ;18:1452-1457.
- 17. Hamatani Y, Nagai T, Nakai M, et al. Elevated plasma d-dimer level is associated with short-term risk of ischemic stroke in patients with acute heart failure. Stroke 2018;49:1737-1740.
- 18. Montaner J, Perea-Gainza M, Delgado P et al. Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke 2008;39:2280-2287.
- 19. Folsom AR, Gottesman RF, Appiah D, Shahar E, Mosley TH. Plasma d-dimer and incident ischemic stroke and coronary heart disease: the atherosclerosis risk in communities study. Stroke 2016;47:18-23.
- 20. Lindner G, Funk GC, Pfortmueller CA, et al. D-dimer to rule out pulmonary embolism in renal insufficiency. Am J Med 2014 ;127:343-347.
- 21. Kovac M, Mikovic Z, Rakicevic L, et al. The use of d-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2010;148:27-30.
- 22. Gutiérrez García I, Pérez Cañadas P, Martínez Uriarte J, et al. D-dimer during pregnancy: establishing trimester-specific reference intervals. Scand J Clin Lab Invest 2018;78:439-442.
D-Dimer Levels and Prognostic Features in Pulmonary Embolism
Year 2022,
Volume: 4 Issue: 2, 58 - 62, 31.08.2022
Burak Kurtoğlu
,
Halil İbrahim Çıkrıklar
,
Vahide Aslıhan Durak
,
Issa Omar
,
Ahmet Münir Yılmaz
,
Sümeyye Tuğba Sarkı Cander
,
Erol Armagan
Abstract
Background: The aim of our study is to investigate the efficacy of D-dimer marker in patients who applied to the emergency department with a preliminary diagnosis of pulmonary embolism.
Materials and methods: This study was conducted retrospectively at Bursa Uludağ University Faculty of Medicine Hospital between January 2018 and December 2018. Patients whose D-dimer levels were checked considering the preliminary diagnosis of pulmonary embolism were included in the study.
Results: A total of 3411 patients were included in the study. In all patients, the diagnosis of PE was made by computed tomography pulmonary angiography. Examination of 1968 patients with (+) D-dimer revealed new diagnosis in 702 patients (35.67%). Pulmonary embolism was diagnosed in a total of 74 patients (10.54%) whereas the most common alternative diagnoses was 33.62% (n=236) pneumonia. On examination of 1443 patients with negative D-dimer levels, pulmonary embolism was diagnosed in 7 (3.14%) patients whereas the most common other diagnoses was 44.84% (n=100) Acute Coronary Syndrome. However, in the D-dimer positive patient group, the rate of newly diagnosed patients requiring clinical and intensive care hospitalization was found to be significantly higher.
Conclusion: In conclusion, even if pulmonary embolism is not detected in D-dimer positive cases, it is thought that these patients need further investigation, considering the frequency of serious conditions requiring clinical and intensive care unit admission.
References
- 1. Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in context: D-Dimer. J Am Coll Cardiol 2017;70:2411-2420.
- 2. Keller K, Beule J, Balzer JO, Dippold W. D-Dimer and thrombus burden in acute pulmonary embolism. Am J Emerg Med 2018 ;36:1613-1618.
- 3. Bass AR, Fields KG, Goto R, Turissini G, Dey S, Russell LA. Clinical decision rules for pulmonary embolism in hospitalized patients: a systematic literature review and meta-analysis. Thromb Haemost 2017;117:2176-2185.
- 4. Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J 2003;20:319–325.
- 5. Geersing GJ, Janssen KJ, Oudega R, et al. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis. BMJ 2009;339:b2990.
- 6. Farm M, Siddiqui AJ, Onelöv L, et al. Age-adjusted D-dimer cut-off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays. J Thromb Haemost 2018;16:866-875.
- 7. Carrier M, Righini M, Djurabi RK, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies. Thromb Haemost 2009;101:886-892.
8. den Exter PL, van Es J, Klok FA, et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood 2013;122:1144-1149.
- 9. Kabrhel C, Mark Courtney D, Camargo CA Jr, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med 2010;17:589-597.
- 10. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014;311:1117-1124.
- 11. Lippi G, Bonfanti L, Saccenti C, Cervellin G. Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med 2014;25:45-48.
- 12. Akbaş SH, Can M, Kılıçarslan I, Özdem S, Çete Y, Gültekin M. Acil Servise Başvuran Yüksek D-dimer Düzeyli Hastalarda Tanı Dağılımı ve D-dimer Düzeylerinin Hastaneye Yatış ve Ölüm Oranları ile İlişkisi. Turk J Emerg Med 2004;4:149-154.
- 13. Falanga A, Russo L, Milesi V, Vignoli A. Mechanisms and risk factors of thrombosis in cancer. Crit Rev Oncol Hematol. 2017;118:79-83.
- 14. Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine 1999;78:285-291.
- 15. Wang S, Zimmermann S, Parikh K, Mansfield AS, Adjei AA. Current Diagnosis and Management of Small-Cell Lung Cancer. Mayo Clin Proc 2019 ;94:1599-1622.
- 16. Stein PD, Gottschalk A, Saltzman HA, Terrin ML. Diagnosis of acute pulmonary embolism in the elderly. J Am Coll Cardiol 1991 ;18:1452-1457.
- 17. Hamatani Y, Nagai T, Nakai M, et al. Elevated plasma d-dimer level is associated with short-term risk of ischemic stroke in patients with acute heart failure. Stroke 2018;49:1737-1740.
- 18. Montaner J, Perea-Gainza M, Delgado P et al. Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke 2008;39:2280-2287.
- 19. Folsom AR, Gottesman RF, Appiah D, Shahar E, Mosley TH. Plasma d-dimer and incident ischemic stroke and coronary heart disease: the atherosclerosis risk in communities study. Stroke 2016;47:18-23.
- 20. Lindner G, Funk GC, Pfortmueller CA, et al. D-dimer to rule out pulmonary embolism in renal insufficiency. Am J Med 2014 ;127:343-347.
- 21. Kovac M, Mikovic Z, Rakicevic L, et al. The use of d-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2010;148:27-30.
- 22. Gutiérrez García I, Pérez Cañadas P, Martínez Uriarte J, et al. D-dimer during pregnancy: establishing trimester-specific reference intervals. Scand J Clin Lab Invest 2018;78:439-442.