D-dimer levels in VTE patients with distal and proximal clots

Sadowski

et al. 2020

Neurol Neurochir Pol.

Aim of the study. We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature. Clinical rationale for the study. CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors. Materials and methods. We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 μg/ml) or elevated (> 0.5 μg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age-and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes. Results. In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 μg/ml (range 0.19-2.45 μg/ml), compared to the control group's mean DD level of 0.50 + 0.45 μg/ml (range 0.15-1.73 μg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 μg/ml-the two highest concentrations in our study group. Conclusions and clinical implications. DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.

Section: Clinical Rationale For the Studymentioning

confidence: 99%

Cerebral venous and sinus thrombosis diagnosis: preliminary study of clinical picture and D-dimer concentration correlation

Sadowski

et al. 2020

Neurol Neurochir Pol.

Front. Cardiovasc. Med.

“…Among the patients with VTE treated with rivaroxaban, PE, proximal DVT, atrial fibrillation, and diabetes mellitus were more common in the high D-dimer group than in the low D-dimer group. Similarly, a previous report showed that patients with proximal DVT and patients with PE with proximal DVT have significantly higher D-dimer concentrations than those with distal DVT ( 18 ).…”

Section: Discussionmentioning

confidence: 60%

Relationship between baseline D-dimer and prognosis in Japanese patients with venous thromboembolism: Insights from the J’xactly study

Migita

Okumura²,

Fukuda³

et al. 2023

BackgroundD-dimer is a biomarker of fibrin production and degradation, and changes in D-dimer concentration suggest fibrin clot formation, which is associated with thromboembolism and hypercoagulable states. Thus, an elevated D-dimer concentration could be a useful prognostic predictor for patients with venous thromboembolism (VTE).Methods and resultsIn this subanalysis of the J’xactly study, a prospective multicenter study conducted in Japan, we examined the clinical outcomes of 949 patients with VTE stratified by baseline D-dimer concentration. The median D-dimer concentration was 7.6 μg/ml (low D-dimer group: <7.6 μg/ml [n = 473, 49.8%]; high D-dimer group: ≥7.6 μg/ml [n = 476, 50.2%]). The mean age of the patients was 68 years, and 386 patients (40.7%) were male. Compared with the low D-dimer group, the high D-dimer group had more frequent pulmonary embolism with or without deep vein thrombosis (DVT), proximal DVT, atrial fibrillation, or diabetes mellitus, and underwent intensive treatment with 30 mg/day rivaroxaban. The incidence of composite clinically relevant events (recurrence or exacerbation of symptomatic VTE, acute coronary syndrome [ACS], ischemic stroke, death from any cause, or major bleeding) was higher in the high D-dimer group than in the low D-dimer group (11.1% vs. 7.5% per patient-year; hazard ratio, 1.46; 95% confidence interval, 1.05–2.04; p = 0.025). There was no significant difference between the high and low D-dimer groups in the incidence of VTE (2.8% vs. 2.5% per patient-year, respectively; p = 0.788), ACS (0.4% per patient-year vs. not observed, respectively; p = 0.078), or major bleeding (4.0% vs. 2.1% per patient-year, respectively; p = 0.087), but there was a significant difference in the incidence of ischemic stroke (1.0% per patient-year vs. not observed, respectively; p = 0.004).ConclusionElevated D-dimer concentration may be an important prognostic predictor in Japanese patients with VTE.Clinical Trial Registration: UMIN CTR, UMIN000025072 (https://www.umin.ac.jp/ctr/index.htm).

The American Journal of Emergency Medicine

“…Singer et al recently performed a prospective study of 1752 low to moderate risk VTE ED patients [ 23 ]. They defined proximal PE as segmental, lobar, or main artery and proximal DVT as proximal to calf trifurcation.…”

Section: Discussionmentioning

confidence: 99%

D-dimer can help differentiate suspected pulmonary embolism patients that require anti-coagulation

Narang

Nowacki

Seballos

et al. 2021

Objectives Determine whether D-dimer concentration in the absence of imaging can differentiate patients that require anti-coagulation from patients who do not require anti-coagulation. Methods Data was obtained retrospectively from 366 hemodynamically stable adult ED patients with suspected pulmonary embolism (PE). Patients were categorized by largest occluded artery and aggregated into: ‘Require anti-coagulation’ (main, lobar, and segmental PE), ‘Does not require anti-coagulation’ (sub-segmental and No PE), ‘High risk of deterioration’ (main and lobar PE), and ‘Not high risk of deterioration’ (segmental, sub-segmental, and No PE) groups. Wilcoxon rank-sum test was used for 2 sample comparisons of median D-dimer concentrations. Receiver operating characteristic (ROC) curve analysis was utilized to determine a D-dimer cut-off that could differentiate ‘Require anti-coagulation’ from ‘Does not require anti-coagulation’ and ‘High risk of deterioration’ from ‘Low risk of deterioration’ groups. Results The ‘Require anti-coagulation’ group had a maximum area under the curve (AUC) of 0.92 at an age-adjusted D-dimer cut-off of 1540 with a specificity of 86% (95% CI, 81–91%), and sensitivity of 84% (79–90%). The ‘High risk of deterioration’ group had a maximum AUC of 0.93 at an age-adjusted D-dimer cut-off of 2500 with a specificity of 90% (85–93%) and sensitivity of 83% (77–90%). Conclusions An age-adjusted D-dimer cut-off of 1540 ng/mL differentiates suspected PE patients requiring anti-coagulation from those not requiring anti-coagulation. A cut-off of 2500 differentiates those with high risk of clinical deterioration from those not at high risk of deterioration. When correlated with clinical outcomes, these cut-offs can provide an objective method for clinical decision making when imaging is unavailable.