A significant decrease in D-dimer concentration within one month of anticoagulation therapy as a predictor of both complete recanalization and risk of recurrence after initial pulmonary embolism

Aranda, Carlos Monserrat; Peralta, Luisa; Gagliardi, Lidia; López, A Henares; Jiménez, Ángel; Herreros, B.

doi:10.1016/j.thromres.2021.02.033

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…It has a high sensitivity (approximately 96%) but a low specificity (approximately 40%) in the diagnosis of PE (Glober et al, 2018;Lei et al, 2021). Pregnancy, cancer, venerable age, chronic inflammatory conditions, and many other illnesses can also increase the content of D-dimer (Choi and Krishnamoorthy, 2018;Aranda et al, 2021), which brings more difficulties to diagnosing PE. According to a retrospective study in 2019, a low pretest clinical probability score (traditional Wells) in a patient with a D-dimer level of less than 1,000 ng per milliliter and a moderate pretest clinical likelihood score in a patient with a D-dimer level of less than 500 ng per milliliter could rule out PE and be protected from radiation (Kearon et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary artery recalculation was achieved in 73 of 80 patients (91.2%) with a 70% or more decrease in D-dimer concentration. Measuring the degree of D-dimer decline can aid clinicians forecast the risk of recurrent PE (Aranda et al, 2021). Several more studies have shown that there was a correlation between D-dimer level and short-term or 3-month mortality (Klok et al, 2008a;Agterof et al, 2009;Kline, 2009;Singanayagam et al, 2011;Bi et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

Shou

et al. 2022

Front. Neuroinform.

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IntroductionPulmonary embolism (PE) is a common thrombotic disease and potentially deadly cardiovascular disorder. The ratio of clinical misdiagnosis and missed diagnosis of PE is very large because patients with PE are asymptomatic or non-specific.MethodsUsing the clinical data from the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China), we proposed a swarm intelligence algorithm-based kernel extreme learning machine model (SSACS-KELM) to recognize and discriminate the severity of the PE by patient’s basic information and serum biomarkers. First, an enhanced method (SSACS) is presented by combining the salp swarm algorithm (SSA) with the cuckoo search (CS). Then, the SSACS algorithm is introduced into the KELM classifier to propose the SSACS-KELM model to improve the accuracy and stability of the traditional classifier.ResultsIn the experiments, the benchmark optimization performance of SSACS is confirmed by comparing SSACS with five original classical methods and five high-performance improved algorithms through benchmark function experiments. Then, the overall adaptability and accuracy of the SSACS-KELM model are tested using eight public data sets. Further, to highlight the superiority of SSACS-KELM on PE datasets, this paper conducts comparison experiments with other classical classifiers, swarm intelligence algorithms, and feature selection approaches.DiscussionThe experimental results show that high D-dimer concentration, hypoalbuminemia, and other indicators are important for the diagnosis of PE. The classification results showed that the accuracy of the prediction model was 99.33%. It is expected to be a new and accurate method to distinguish the severity of PE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

Shou

et al. 2022

Front. Neuroinform.

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“…Overall, 12 studies provided data on presence of pulmonary perfusion defects or residual vascular obstruction during acute PE follow-up as well as functional outcomes and were included in this systematic review. [17][18][19][20][21][22][23][24][25][26][27][28][29]…”

Section: Study Selectionmentioning

confidence: 99%

“…Four studies provided the localization of emboli (central/peripheral) at the baseline PE imaging test. 17,19,20,25 Five studies reported on the number of patients that underwent reperfusion treatment (range 2-16%). 17,[25][26][27][28][29] Seven studies reported the number of patients with right ventricular dysfunction at index PE; the proportion ranged from 17 to 66%.…”

Section: Included Studiesmentioning

confidence: 99%

“…17,[25][26][27][28][29] Seven studies reported the number of patients with right ventricular dysfunction at index PE; the proportion ranged from 17 to 66%. [19][20][21][25][26][27][28][29] The timing of the follow-up procedures ranged from 2 months after the index PE episode up to 72 months, but were mostly within 3-12 months (11 of 12 studies). Presence of pulmonary perfusion defects or residual vascular obstruction during follow-up was assessed in four studies by CTPA to evaluate residual vascular obstruction, six studies used V/Q scan to evaluate perfusion defects and one study used a Q-scan only.…”

Section: Included Studiesmentioning

confidence: 99%

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Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis

Cimini,

Luijten,

Barco

et al. 2024

ERJ Open Res

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IntroductionUp to 50% of pulmonary embolism (PE) patients has perfusion defects or residual vascular obstruction during follow-up despite adequate anticoagulant treatment and a similar percentage experience chronic functional limitations and/or dyspnea post-PE. We aimed to evaluate the association between pulmonary perfusion defects or residual vascular obstruction and functional recovery after PE.MethodsWe performed a systematic review and meta-analysis including studies assessing both the presence of perfusion defects or residual vascular obstruction and functional recovery (i.e.persistent symptoms, quality of life, exercise endurance). An odds-ratio (OR) was pooled for perfusion defects or residual vascular obstruction and persistent symptoms using a random-effect model.Results12 studies were included totaling 1888 PE patients; at a median of 6 months after PE (range 2–72), 34% had perfusion defects or residual vascular obstruction and 37% reported persistent symptoms. Among patients with perfusion defects or residual vascular obstruction, 48% (95%CI 37–60, I2=82%) remained symptomatic during follow-up, compared to 34% (95%CI 20–51, I2=96%) of patients without such defects. Presence of perfusion defects or residual vascular obstruction was associated with persistent symptoms (OR 2.15, 95%CI 1.66–2.78; I2=0%, τ=0). Notably, there was no association between these defects and quality of life or cardiopulmonary exercise test parameters.ConclusionWhile the odds of having persistent symptoms was higher in patients with perfusion defects or residual vascular obstruction after acute PE, a significant proportion of these patients reported no limitations. A possible causality between perfusion defects or residual vascular obstruction and residual functional limitation therefore remains to be proven.

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Reduced fibrin clot permeability on admission and elevated E-selectin at 3 months as novel risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism

Stępień,

Ząbczyk,

Kopytek

et al. 2023

J Thromb Thrombolysis

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Background Residual pulmonary vascular obstruction (RPVO) is common following pulmonary embolism (PE) but its association with fibrin clot properties is poorly understood. We investigated whether prothrombotic state and hypofibrinolysis markers can identify patients with RPVO. Methods In 79 normotensive noncancer patients (aged 56 ± 13.3 years) with acute PE, we determined fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), fibrinolysis proteins, oxidative stress markers, and E-selectin on admission before initiation of anticoagulant therapy, after 5–7 days, and 3 months of anticoagulation. RPVO was diagnosed using computed tomography angiography 3–6 months since PE. Results Patients with RPVO (n = 23, 29.1%) had at baseline higher simplified Pulmonary Embolism Severity Index (sPESI) (P = 0.004), higher N-terminal brain natriuretic propeptide (P = 0.006) and higher D-dimer (P = 0.044). Patients with versus without RPVO had lower Ks (P < 0.001) and longer CLT (P < 0.05), both at baseline and 5–7 days since admission, but not at 3 months. Patients with RPVO showed 40.6% higher E-selectin (P < 0.001) solely at 3 months. By multivariable logistic regression, baseline Ks (odds ratio [OR] 0.010, 95% confidence interval [CI] 0.001–0.837, P = 0.042, per 10− 9 cm2), baseline D-dimer (OR 1.105, 95% CI 1.000-1.221, P = 0.049, per 100 ng/ml), and E-selectin levels after 3 months (OR 3.874, 95% CI 1.239–12.116, P = 0.020, per 1 ng/ml) were associated with RPVO. Conclusions RPVO patients despite anticoagulation characterize with the formation of denser fibrin clots on admission and higher E-selectin at 3 months. Those parameters could be the potential novel RPVO risk factors that warrant further evaluation in an independent cohort. Graphical Abstract

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A significant decrease in D-dimer concentration within one month of anticoagulation therapy as a predictor of both complete recanalization and risk of recurrence after initial pulmonary embolism

Cited by 7 publications

References 24 publications

A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China

Pulmonary perfusion defects or residual vascular obstruction and persistent symptoms after pulmonary embolism: a systematic review and meta-analysis

Reduced fibrin clot permeability on admission and elevated E-selectin at 3 months as novel risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism

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