Association of D-dimer with short-term risk of venous thromboembolism in acutely ill medical patients: A systematic review and meta-analysis

Chi, Gerald; Lee, Jane; Montazerin, Sahar Memar; Marszałek, Jolanta

doi:10.1177/1358863x221109855

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…In the UK, the National Institute for Health and Care Excellence (NICE) support the use of the Wells score with a D-dimer test (11,12) and computed tomography pulmonary angiography (CTPA) or ventilation-perfusion scan (VQ) for a suspected PE or ultrasound scans (USS) for a suspected DVT (13) . This approach has a very low rate of diagnostic failure (14)(15)(16) . However, a large increase in CTPAs and ultrasounds has been seen for suspected PE/DVT, placing a significant burden on diagnostic services (17,18) .…”

Section: Introductionmentioning

confidence: 99%

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Gallier,

Evison,

Hodson

et al. 2024

Preprint

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ObjectiveDespite recommendations, age adjusted thresholds (AAT) for D Dimers are not routinely used as part of venous thromboembolism (VTE) screening in many healthcare settings due to concerns about missing cases, especially in older and co-morbid adults. The National Institute for Health and Care Excellence in the UK has highlighted that evidence to support AAT is not plentiful. This study assessed the real-world use of AAT D-dimers for VTE in a large cohort of acutely hospitalised patients.MethodsThis retrospective data study included all adult patients attending a large hospital with a suspected VTE between January 2017 to December 2021. The predictive accuracy of D-dimer was assessed against gold standard imaging. Outcomes of false negative (with AAT) and false positives (with standard thresholds) cases were assessed.Results27,526 suspected VTE attendances were included, with a 4.3% confirmed VTE diagnosis rate. The ST D-dimer exhibited high sensitivity (91.1%) but modest specificity (65.2%). The AAT demonstrated slightly lower sensitivity (87.0%) but higher specificity (71.7%, p<0.001). The performance of ST thresholds declined with age, with false positive rates increasing from 17.4% to 80.0% in people aged < 50 years and > 90 years respectively. The AAT accurately identified 1,700 true negatives misclassified as false positives by the ST. 14 patients in this group were admitted with a bleed within 30 days. AAT misdiagnosed 24 cases as false negatives, with most being small sub-segmental pulmonary emboli or non-occlusive DVTs. Using AAT thresholds could have avoided 64 scans per 1,000 attendances, saving approximately £235,310 of imaging costs in this cohort.ConclusionThe age-adjusted D-dimer threshold enhances diagnostic precision and could decrease unnecessary imaging and anticoagulation, reducing investigations with time and cost savings with no significant safety signal.

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Section: Introductionmentioning

confidence: 99%

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Gallier,

Evison,

Hodson

et al. 2024

Preprint

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Hospital predictors of deep vein thrombosis after ischemic stroke: A systematic review

Torokulova,

Bijalieva,

Akulich

et al. 2024

HVT

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In the acute stage of ischemic stroke, deep vein thrombosis (DVT) is more common than in the recovery stage. The stratification of the risk of developing DVT is crucial when making a decision in terms of correct diagnostic and treatment options in stroke patients. The aim of the study was to review systematically up-to-date published studies on predictors for DVT in patients with acute ischemic stroke. Methods: Study design -systematic review of observational studies. Russian scientific citation database of RSCI, English scientific citation database of PubMed, Web of Science, Embase for the period of time 2018-August 2023 were used for studies search. Data from selected studies were extracted, including study design, data source, outcome definition, sample size, and predictors. The most common demographic, clinical and/or laboratory markers for predicting strokerelated DVT were presented. Results: Totally 234 studies were reviewed, and after the selection process, nine studies were included in this article. The incidence of DVT in patients with acute ischemic stroke ranged from 0.53 % to 19.8 %. The most frequently pointed predictors were D-dimer level, age, sex, lower limb plegia, and high NIHHS scores. Conclusion: Identification of individuals with high risk of venous limb thrombosis after ischemic stroke is crucial for targeted thromboprophylaxis. Advanced knowledge of predictors and biomarkers is needed to guide clinical decisionmaking and develop risk prediction models.

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Predictors of deep-vein thrombosis for acute stroke at admission to a rehabilitation unit: A retrospective study

Wei

Huo

et al. 2023

Front. Neurol.

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BackgroundDeep-vein thrombosis (DVT) is a common complication of acute stroke (AS). Only limited studies have discussed DVT in patients with AS at admission to a rehabilitation unit. The purpose of this study is to identify the predictors of DVT in AS patients admitted to a rehabilitation unit in China.MethodsWe retrospectively reviewed the medical records of all patients with AS admitted within 14 days of stroke onset between July 2019 and June 2022 at the Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, China. Ultrasonography was used to diagnose DVT in all patients within 3 days after rehabilitation admission. Univariate and binary logistic regression analyses were performed to determine the risk factors for DVT.ResultsOverall, 234 cases were identified and the incidence rate of DVT among AS patients was 13.2% (31/234). The univariate analysis showed that age, drinking, lower limb muscle strength, Brunnstrom Assessment (BRS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Barthel Index (BI) scale, serum albumin (Alb), and D-dimer were statistically significant factors. Age (OR = 1.037, 95% CI = 1.000–1.075, p < 0.05), BBS (OR = 0.952, 95% CI = 0.913–0.993, p < 0.05), and D-dimer (OR = 1.446, 95% CI = 1.130–1.849, p < 0.05) were demonstrated as independent risk factors for DVT.ConclusionOlder age, lower BBS, and higher D-dimer levels at rehabilitation admission were independent risk factors for DVT. Therefore, ultrasonography should be performed for those patients with these three significant factors before implementing rehabilitation therapy.

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Association of D-dimer with short-term risk of venous thromboembolism in acutely ill medical patients: A systematic review and meta-analysis

Cited by 3 publications

References 42 publications

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Hospital predictors of deep vein thrombosis after ischemic stroke: A systematic review

Predictors of deep-vein thrombosis for acute stroke at admission to a rehabilitation unit: A retrospective study

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