Role of repeat pulmonary angiography and D-dimer testing in pulmonary thromboembolism evaluation among COVID-19 patients

Yıl 2025, Cilt: 6 Sayı: 5, 520 - 525, 24.10.2025

Kerem Ensarioğlu , Aynur Yurtseven , Yasemin Yılmaz Aydın , Bahar Kurt

Öz

Aims: Pulmonary thromboembolism (PE) is a life-threatening condition in pulmonary medicine. It is commonly diagnosed in emergency medicine via computed tomography pulmonary angiography (CTPA). D-dimer is a well-established diagnostic marker for PE, and repeated imaging and testing are often part of follow-up protocols. This study investigates whether the presence or severity of PE influences the need for repeated imaging and D-dimer testing among patients diagnosed with coronavirus disease 2019 (COVID-2019).
Methods: The study included patients evaluated in the emergency department for PE and were then on routine follow-up at one week, one month, three months, and six months. PE diagnoses were confirmed by CTPA and categorized by severity.
Results: Of the 149 patients, 55.7% were diagnosed with PE, with most cases being severe. Over six months, the mortality rate was 6.7%. Repeat CTPA was done in 67.1% of patients, but severity did not correlate with repeat imaging frequency. D-dimer levels decreased over time except in patients with recurrent PE. High initial D-dimer was associated with PE diagnosis but did not influence subsequent imaging requests.
Conclusion: D-dimer levels are reduced over time in patients without confirmed PE, implying a reduced need for repeat imaging if levels are low. Variations in repeat testing practices suggest over-testing may occur, influenced by clinical judgment rather than guidelines. D-dimer levels did not significantly impact repeat CTPA requests, and severe PE cases did not require more frequent imaging among patients diagnosed with COVID-19. Routine repeat imaging may not be necessary in patients with declining
D-dimer levels post-initial evaluation.

Anahtar Kelimeler

Computed tomography pulmonary angiography , D-dimer , emergency medicine , pulmonary embolism

Etik Beyan

The study was initiated after the approval of the hospital’s local ethics committee (23.05.2022 Decision date, approval number 138/08) as a retrospective cohort. The patient consent form was waived as per from the ethics committee, due to the retrospective nature of the study. The patients’ data were accessed for a period of three months after the ethics approval for the investigation. Authors only had access to information that could identify during the initial screening process of data collection, afterwards, patients’ identification was removed with anonymous ID numbers assigned to them.

COVID-19 hastalarında pulmoner tromboemboli değerlendirilmesinde tekrarlayan pulmoner anjiyografi ve D-dimer testinin rolü

Öz

Giriş
Pulmoner tromboemboli (PTE), göğüs hastalıklarında yaşamı tehdit eden bir durumdur. Acil serviste genellikle bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile tanı konur. D-dimer, PTE için iyi tanımlanmış bir tanı belirtecidir ve takip protokollerinde tekrarlayan görüntüleme ve testler sıkça yer almaktadır. Bu çalışma, Koronavirüs Hastalığı 2019 (COVID-2019) tanısı almış hastalarda PTE varlığı veya şiddetinin tekrarlayan görüntüleme ve D-dimer testine duyulan ihtiyacı etkileyip etkilemediğini araştırmaktadır.

Gereç ve Yöntemler
Çalışmaya acil serviste PTE açısından değerlendirilen ve ardından birinci hafta, birinci ay, üçüncü ay ve altıncı ayda rutin takipleri yapılan hastalar dahil edildi. PTE tanıları BTPA ile doğrulandı ve şiddetine göre sınıflandırıldı.

Bulgular
149 hastanın %55,7’sine PTE tanısı konuldu ve vakaların çoğu ağırdı. Altı aylık süreçte mortalite oranı %6,7 idi. Hastaların %67,1’ine tekrar BTPA yapıldı, ancak şiddet ile tekrarlayan görüntüleme sıklığı arasında ilişki saptanmadı. D-dimer düzeyleri, tekrarlayan PTE’si olanlar dışında, zamanla azalma gösterdi. Yüksek başlangıç D-dimer düzeyleri PTE tanısı ile ilişkiliydi ancak sonraki görüntüleme taleplerini etkilemedi.

Tartışma
Doğrulanmış PTE’si olmayan hastalarda D-dimer düzeyleri zamanla azalmakta, bu da düşük düzeylerde tekrar görüntülemeye duyulan ihtiyacın azaldığını göstermektedir. Tekrarlayan test uygulamalarındaki farklılıklar, kılavuzlardan ziyade klinik yargıya bağlı olarak ek test yapılabileceğini düşündürmektedir.

Sonuç
D-dimer düzeyleri, tekrar BTPA taleplerini anlamlı şekilde etkilememiştir ve ağır PTE vakaları, COVID-19 tanılı hastalarda daha sık görüntüleme gerektirmemiştir. İlk değerlendirme sonrası D-dimer düzeyleri düşen hastalarda rutin tekrarlayan görüntülemeye gerek olmayabilir.

Anahtar Kelimeler

Bilgisayarlı Tomografi Pulmoner Anjiyografi , D-Dimer , Acil Tıp , Pulmoner Emboli

Kaynakça

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