D‐dimer testing versus multislice computed tomography in the diagnosis of postpartum pulmonary embolism in symptomatic high‐risk women

Hassanin, Ibrahim M.A.; Shahin, Ahmed Y.; Badawy, Mohamed; Karam, K.

doi:10.1016/j.ijgo.2011.05.024

Cited by 15 publications

(15 citation statements)

References 3 publications

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“…Studies of the D-dimer measurement in pregnant and postpartum women 8,13,16,17 suggest that high levels of positivity at conventional thresholds limit the diagnostic value of this test. However, indirect evidence from studies of the D-dimer measurement for suspected DVT in pregnancy suggests potential diagnostic value.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Barrit and Jordan 70 conducted a small randomised controlled trial in one hospital that showed that the odds ratios for untreated people with PE compared with people treated with anticoagulation treatment were 6.923 (95% CI 0.734 to 65.259) for all-cause mortality (6/19 vs. 1/16), 16.667 (95% CI 1.818 to 152.770) for recurrent VTE or death (1/16 vs. 10/19) and 12.517 (95% CI 0.636 to 246.384) for odds ratio for fatal PE (0/16 vs. 5/19). For people who were untreated, their risk of death from PE was modified using the odds ratio estimated for the risk of death from a fatal PE, their risk of a recurrent VTE was modified using the odds ratio estimated for the risk of recurrent VTE or death and their risk of a CTEPH event was modified using the odds ratio estimated for the risk of recurrent VTE or death.…”

Section: Adjustments If a Women With A Pulmonary Embolism Did Not Recmentioning

confidence: 99%

“…The base case used data from the study by Fogehom et al, 75 which suggested that the annual risk of dying after a stroke compared with the general Finish population was 4.5-fold in the first year, 2.2-fold in years 2-6 and 0.9-fold in years [7][8][9][10][11][12][13][14][15][16]. 75 The population analysed had a mean age of 67.3 years, and 48.4% of the population were male.…”

Section: Life Expectancy After An Intracranial Haemorrhagementioning

confidence: 99%

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Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Goodacre

Horspool

Shephard

et al. 2018

Health Technol Assess

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Article:Goodacre, S. orcid.org/0000-0003-0803-8444, Horspool, K., Shephard, N. et al. (8 more authors) (2018) Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling. Health Technology Assessment, 22 (47). ISSN 1366-5278 https://doi.org/10.3310/hta22470 © Queen's Printer and Controller of HMSO 2018. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). HEALTH TECHNOLOGY ASSESSMENTEditorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health techno...

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Section: Literature Reviewmentioning

confidence: 99%

Section: Adjustments If a Women With A Pulmonary Embolism Did Not Recmentioning

confidence: 99%

Section: Life Expectancy After An Intracranial Haemorrhagementioning

confidence: 99%

See 1 more Smart Citation

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Goodacre

Horspool

Shephard

et al. 2018

Health Technol Assess

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“…These PE cases were diagnosed based on the clinical manifestations and the results from radiological and laboratory tests, in line with the standard literature (22). Furthermore, a further 30 healthy subjects, 15 males and 15 females, aged 30-88 years (with an average age of 56.5 years), were used as the control group.…”

Section: Patientsmentioning

confidence: 99%

Homocysteine injures vascular endothelial cells by inhibiting mitochondrial activity

Yang

Gao

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the role of homocysteine (Hcy) in the pathogenesis of pulmonary embolism (PE) and the associated molecular mechanisms in human umbilical vein endothelial cells (HUVECs). Hcy contents were detected with high-performance liquid chromatography. Apoptosis was detected by flow cytometry using Annexin-V staining. Cytochrome c oxidase (COX) activity was assessed with an enzyme activity assay, and the expression levels of COX 17 were determined by western blot analysis. Intracellular reactive oxygen species levels were measured using a microplate reader with a fluorescence probe. The results demonstrated that, compared with the control group, the serum Hcy levels were significantly elevated in the PE group, suggesting that Hcy may be an indicator for PE. Following treatment with Hcy, the apoptosis rate was markedly elevated in HUVECs. Moreover, Hcy decreased COX activity and downregulated the expression of COX 17 in HUVECs. Furthermore, Hcy increased the ROS levels in these endothelial cells. However, all the above-mentioned physiopathological changes induced by Hcy in HUVECs could be restored by folic acid. In conclusion, the results of the present study demonstrated that Hcy inhibited COX activity, downregulated COX 17 expression, increased intracellular ROS levels and enhanced apoptosis in endothelial cells. IntroductionPulmonary embolism (PE) is a frequent clinical syndrome with abnormal pulmonary circulation, which is predominantly caused by the blockage of pulmonary and/or bronchial arteries by thrombus shedding (1). Due to the sudden disease onset, PE is difficult to treat and usually results in the patient succumbing to the disease (2,3). Homocysteine (Hcy) is an intermediate product of methionine metabolism, and is an independent risk factor for cardiovascular diseases (4,5). Previous studies reported that serum Hcy levels are markedly elevated in patients with PE, which is implicated in the disease pathogenesis (6-8).Vessel wall injury is one of the important factors for PE, as the pathological changes in endothelial cells may result in the formation of thrombosis (9,10). It has been demonstrated that high concentrations of Hcy induce apoptosis in endothelial cells (11,12), in which mitochondria are involved. Cytochrome c oxidase (COX) is a key enzyme in mitochondrial function (13)(14)(15). Enhanced COX activity may increase intracellular reactive oxygen species (ROS) levels, resulting in cellular apoptosis (16)(17)(18)(19)(20)(21). Based on these reports, it would be of interest to define the association between Hcy, COX, and ROS in apoptosis, specifically in the context of PE pathogenesis.In the present study, the effects of Hcy on endothelial cells and the associated molecular mechanisms were investigated. Materials and methods Patients.A total of 10 patients with PE, 4 males and 6 females, aged 50-67 years (with an average age of 60.4 years), were included in this study. These PE cases were diagnosed based on the clinical manifestations and the resu...

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“…Studies of D-dimer in pregnant and postpartum women7 14 17 18 suggest that high levels of positivity at conventional thresholds limit the diagnostic value of this test. However, indirect evidence from studies of D-dimer for suspected DVT in pregnancy suggests potential diagnostic value.…”

Section: Can Clinical Features Clinical Prediction Scores or Biomarkmentioning

confidence: 99%

When should we use diagnostic imaging to investigate for pulmonary embolism in pregnant and postpartum women?

et al. 2014

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Pulmonary embolism (PE) is a leading cause of death in pregnancy and postpartum. Clinicians face a difficult choice when deciding whether to use diagnostic imaging to investigate for suspected PE in these patients, between risking potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking unnecessary iatrogenic harm to both mother and fetus if imaging is overused. This paper explores the options for imaging and evidence for the use of clinical features, clinical predictions scores or biomarkers to select pregnant and postpartum women for imaging. It also considers where future research could be most appropriately directed.

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D‐dimer testing versus multislice computed tomography in the diagnosis of postpartum pulmonary embolism in symptomatic high‐risk women

Cited by 15 publications

References 3 publications

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Homocysteine injures vascular endothelial cells by inhibiting mitochondrial activity

When should we use diagnostic imaging to investigate for pulmonary embolism in pregnant and postpartum women?

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