The clinical significance of D-dimer concentrations in patients with gestational hypertensive disorders according to the severity

Abstract

ObjectivePregnancy is a major risk factor of thromboembolism, and the patients with preeclampsia (PE) are known to have higher risk of thromboembolic complications than normal pregnant women. D-dimer is a well-established laboratory marker for the screening of venous thromboembolism (VTE), but the concentrations of d-dimer tend to increase physiologically in pregnant women throughout the gestational age. We performed this study to evaluate the clinical significance of d-dimer concentrations in patients with gestational hypertensive disorders (GHD) according to the severity.MethodsRetrospective cohort study was performed in one institution. Singleton pregnant women with GHD were enrolled, and their antepartum concentrations of d-dimer were measured as a part of routine evaluation for patients suspected with PE. Patients with multiple gestations, rheumatic diseases, autoimmune diseases, or suspected VTE were excluded. A categorization of severity about PE was based on the general criteria.ResultsIn 73.3% of study population, their d-dimer concentrations exceeded the normal range (>0.55 mg/L). A significantly greater proportion of pregnant women had excessive concentrations of d-dimer in the severe GHD than in the non-severe GHD (89.8% vs. 53.7%; P<0.01). Patients with severe GHD had significantly higher median concentrations of d-dimer than those with non-severe GHD (median [range], 2.00 mg/L [0.11 to 7.49] vs. 0.71 mg/L [0.09 to 5.39]; P<0.01) although their earlier gestational ages of sampling.ConclusionMaternal concentrations of d-dimer were significantly elevated in patients with severe features than those without severe features among those with GHD. Some pregnant women with GHD can have markedly elevated concentrations of d-dimer without any evidence of current VTE.

Elevated levels of D‐dimer tested by immunoturbidimetry are associated with the extent of severity of pre‐eclampsia

“…2), with a high positive predictive value of 94.4% and a positive likelihood ratio of 8.5. Dusse et al 19 and Kim et al 21 found a significant elevation of D-dimer in patients with severe pre-eclampsia versus patients without criteria for severity. Similarly, the present study found a significant association between elevated D-dimer levels (>97.5 percentile for gestational age) and patients with criteria of severity (19.3% vs 2.3%.…”

“…It has also been confirmed that D-dimer is significantly elevated in pregnant patients who have severe pre-eclampsia versus normotensive patients or those with mild pre-eclampsia. 19,21 Moreover, Pinheiro et al 1 found that D-dimer is an excellent predictor of the severity of pre-eclampsia, with an area under the receiver operating characteristic (ROC) curve of 90%.…”

Evaluation of Plasma D-Dimer Concentration Among Normal and Complicated Pregnancies, Saudi Arabia

“…Our results agreed with the recent study by Kim et al in 2017, which investigated the clinical importance of D-dimer amounts in GH patients according to the severity of the disease. They stated that 80% of patients with GH who enrolled in their study had substantial elevations in the concentration of D-dimer (19). They also uncovered that the average of D-dimer concentration was notably greater in patients with severe GH than in those with nonsevere GH (19).…”

“…They stated that 80% of patients with GH who enrolled in their study had substantial elevations in the concentration of D-dimer (19). They also uncovered that the average of D-dimer concentration was notably greater in patients with severe GH than in those with nonsevere GH (19). Nevertheless, due to the variances in the averages of D-dimer concentrations among females with severe GH and non-severe GH, D-dimer cannot be used as an indicator or screening tool for identifying severe GH.…”

“…Nevertheless, due to the variances in the averages of D-dimer concentrations among females with severe GH and non-severe GH, D-dimer cannot be used as an indicator or screening tool for identifying severe GH. Moreover, as the severity of GH increased with each gestational stage, the substantial increase in D-dimer in these women was also noted (19). However, they failed to investigate the D-dimer concentrations during pregnancy in relation to the gestational period for comparison.…”