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d dimer for pulmonary embolism

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https://www.readbyqxmd.com/read/28075426/age-adjusted-plasma-d-dimer-levels-in-suspected-acute-pulmonary-embolism-a-retrospective-single-center-study
#1
Marta Kozłowska, Magdalena Pływaczewska, Michał Ciurzyński, Szymon Pacho, Marzanna Paczyńska, Zenon Truszewski, Maciej Kostrubiec, Anna Wyzgał, Piotr Palczewski, Marcin Koć, Dorota Matuszewicz, Piotr Pruszczyk
INTRODUCTION    In older patients the conventional D-Dimer threshold (CDD) is characterized by high sensitivity and low specificity in diagnosing acute pulmonary embolism (APE). A higher cut-off level for D-Dimer has been proposed, aiming at increasing specificity while maintaining high sensitivity, which is calculated by multiplying the patients' ages in years by a coefficient of ten (YADD10). OBJECTIVES    To validate the clinical value of YADD10 in patients with suspected APE and to optimize this threshold to  achieve increased specificity paired with high sensitivity...
January 10, 2017: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/28039291/can-recombinant-human-thrombomodulin-increase-survival-among-patients-with-severe-septic-induced-disseminated-intravascular-coagulation-a-single-centre-open-label-randomised-controlled-trial
#2
Akiyoshi Hagiwara, Noriko Tanaka, Tatsuki Uemura, Wataru Matsuda, Akio Kimura
OBJECTIVE: To determine whether treatment with recombinant human thrombomodulin (rhTM) increases survival among patients with severe septic-induced disseminated intravascular coagulation (DIC). DESIGN: Single-centre, open-label, randomised controlled trial. SETTING: Single tertiary hospital. PARTICIPANT: 92 patients with severe septic-induced DIC. INTERVENTIONS: Patients with DIC scores ≥4, as defined by the Japanese Association of Acute Medicine, were diagnosed with DIC...
December 30, 2016: BMJ Open
https://www.readbyqxmd.com/read/28002070/retrospective-validation-of-the-pulmonary-embolism-rule-out-criteria-rule-in-pe-unlikely-patients-with-suspected-pulmonary-embolism
#3
Steven Crane, Tom Jaconelli, Mazin Eragat
INTRODUCTION: Patients presenting to emergency departments (EDs) with suspected pulmonary embolism (PE) can be risk stratified and those who are deemed to be at low risk for PE usually undergo D-dimer testing. A negative D-dimer in this low-risk group rules out PE with a high degree of certainty because of its high sensitivity. The D-dimer is, however, a poorly specific test and positive results often lead to unnecessary radiological imaging (notably computed tomography pulmonary angiography)...
December 19, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27991422/volumetric-capnography-in-the-exclusion-of-pulmonary-embolism-at-the-emergency-department-a-pilot-study
#4
Timon M Fabius, Michiel M Eijsvogel, Ivo van der Lee, Marjolein G J Brusse-Keizer, Frans H de Jongh
The analysis of the [Formula: see text] in expired air as a function of the exhaled volume (volumetric capnography) might result in a more specific exclusion tool for pulmonary embolism (PE) in addition to the Wells-score and D-dimer. A novel combination of volumetric capnography parameters ([Formula: see text]) should be decreased in PE and could possibly be used to decrease the number of requested computed tomography pulmonary angiograms (CTPA). Volumetric capnography measurements were performed on consecutive patients seen in the emergency department for which, due to suspected PE (due to increased D-dimer level or Wells-score), a CTPA was ordered...
December 17, 2016: Journal of Breath Research
https://www.readbyqxmd.com/read/27979674/a-treatment-strategy-using-subcutaneous-fondaparinux-followed-by-oral-rivaroxaban-is-effective-for-treating-acute-venous-thromboembolism
#5
Takayuki Kabuki, Rine Nakanishi, Shinji Hisatake, Takahiro Fujii, Shintaro Dobashi, Shingo Wakakura, Shunsuke Kiuchi, Tadashi Fujino, Takanori Ikeda
BACKGROUND: The factor Xa inhibitors have been widely used for the treatment and prevention of venous thromboembolism (VTE). However, the efficacy of factor Xa inhibitors in Japanese patients with VTE has not been well examined. In this study, we investigated the effect of the sequential use of two factor Xa inhibitors in patients with acute VTE. METHODS: We conducted an observational study of 87 consecutive patients diagnosed with VTE. As an initial treatment, we administered subcutaneous fondaparinux to the patients for 7-10 days, and then switched to oral rivaroxaban...
December 12, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27966438/never-ignore-extremely-elevated-d-dimer-levels-they-are-specific-for-serious-illness
#6
T Schutte, A Thijs, Y M Smulders
BACKGROUND: D-dimer is routinely measured as part of the clinical diagnosis algorithms for venous thromboembolism (VTE). In these algorithms, low D- dimer cut-off values are used to generate a dichotomous test result that is sensitive, but very non-specific for VTE. A consequence of any test dichotomisation is loss of information that is hidden in the continuous spectrum of results. For D-dimer, the information conveyed by extremely elevated results may be particularly relevant. Our aim was to assess the differential diagnosis of extremely elevated D-dimer levels in a hospital setting...
December 2016: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/27966013/choice-of-marker-for-assessment-of-rv-dysfunction-in-acute-pulmonary-embolism-nt-probnp-pulmonary-artery-systolic-pressure-mean-arterial-pressure-or-blood-pressure-index
#7
H Ates, I Ates, H Kundi, F M Yilmaz
BACKGROUND: We aimed to examine the value of NT-proBNP, pulmonary artery systolic pressure (PASP), blood pressure index (BPI), and mean arterial pressure (MAP) in the determination of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). PATIENTS AND METHODS: A total of 547 patients diagnosed with APE were included in the study. Demographic characteristics and comorbid conditions of patients were recorded in patient files. For blood pressure measurement, a calibrated digital blood pressure monitor was used at regular intervals...
December 13, 2016: Herz
https://www.readbyqxmd.com/read/27941007/age-adjusted-d-dimer-excludes-pulmonary-embolism-and-reduces-unnecessary-radiation-exposure-in-older-adults-retrospective-study
#8
Jennifer Nobes, Claudia-Martina Messow, Mohammed Khan, Petr Hrobar, Chris Isles
BACKGROUND: Patients in whom a diagnosis of pulmonary embolism (PE) is suspected and whose D-dimers are elevated frequently require CT pulmonary angiogram (CTPA) for diagnosis. Because D-dimer rises with age, an age-adjusted D-dimer threshold may prevent unnecessary radiation exposure from CTPA in older patients. OBJECTIVE: To determine the efficacy and safety of implementing an age-adjusted D-dimer threshold to exclude PE. DESIGN, SETTINGS AND PATIENTS: Retrospective comparison of conventional and age-adjusted D-dimer thresholds in 1000 consecutive patients who had both D-dimer and CTPA...
December 9, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27939016/diagnosing-pulmonary-embolisms-the-clinician-s-point-of-view
#9
A Carrillo Alcaraz, A López Martínez, F J Sotos Solano
Pulmonary thromboembolism is common and potentially severe. To ensure the correct approach to the diagnostic workup of pulmonary thromboembolism, it is essential to know the basic concepts governing the use of the different tests available. The diagnostic approach to pulmonary thromboembolism is an example of the application of the conditional probabilities of Bayes' theorem in daily practice. To interpret the available diagnostic tests correctly, it is necessary to analyze different concepts that are fundamental for decision making...
December 7, 2016: Radiología
https://www.readbyqxmd.com/read/27932745/-association-of-deep-venous-thrombosis-with-d-dimer-values-in-patients-with-hemorrhagic-stroke
#10
Atsushi Arai, Junji Koyama, Taichiro Imahori, Ryoji Shiomi, Hirofumi Iwahashi, Kazuhiro Tanaka, Eiji Kohmura
Pulmonary embolism(PE)in the early phase of stroke worsens the prognosis. It is necessary to detect deep venous thrombosis(DVT)to avoid PE. We conducted the D-dimer screening in order to detect DVT at an earlier stage. We retrospectively analyzed the clinical data of patients with hemorrhagic stroke who were admitted to the local stroke center, and investigated the complication rates of DVT, PE, D-dimer values, and risk factors of DVT. From October 2012 to August 2014, 261 patients were included. DVT was detected in 46 patients(17...
December 2016: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/27925452/usefulness-of-admission-red-blood-cell-distribution-width-as-a-predictor-of-severity-of-acute-pulmonary-embolism
#11
Recep Akgedik, Harun Karamanli, Ali Bekir Kurt, Zeki Yüksel Günaydın
BACKGROUND: Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE. OBJECTIVES: In our investigation, we purposed to assess the relation between PAOI and RDW and the benefit of these factors in the detection of PE severity...
December 7, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/27913507/diagnosis-of-suspected-venous-thromboembolism
#12
Clive Kearon
The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27861367/impact-of-acute-kidney-injury-on-coagulation-in-adult-minimal-change-nephropathy
#13
Meng-Jie Huang, Ri-Bao Wei, Ting-Yu Su, Yang Wang, Qing-Ping Li, Xi Yang, Xiao-Meng Lv, Xiang-Mei Chen
A hypercoagulable state exists in patients with nephrotic syndrome (NS), which more easily leads to venous thromboembolism (VTE). However, whether acute kidney injury (AKI), a common complication of NS, affects the hypercoagulable state and VTE has rarely been elucidated. In this study, we aimed to explore coagulation changes and analyze relevant influencing factors in NS-AKI patients.A total of 269 consecutive NS patients with minimal change disease (MCD) between 2011 and 2016 were included in this observational study...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27859891/diagnostic-performance-of-wells-score-combined-with-point-of-care-lung-and-venous-ultrasound-in-suspected-pulmonary-embolism
#14
Peiman Nazerian, Giovanni Volpicelli, Chiara Gigli, Cecilia Becattini, Giuseppe Francesco Sferrazza Papa, Stefano Grifoni, Simone Vanni
OBJECTIVE: Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated. METHODS: We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators...
November 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27803754/the-diagnostic-significance-of-signal-peptide-complement-c1r-c1s-uegf-and-bmp1-epidermal-growth-factor-domain-containing-protein-1-levels-in-pulmonary-embolism
#15
Nigar Dirican, Ali Duman, Gülcan Sağlam, Akif Arslan, Onder Ozturk, Sule Atalay, Ahmet Bircan, Ahmet Akkaya, Munire Cakir
BACKGROUND: Pulmonary embolism (PE) is a common and potentially life-threatening disorder. Patients with PE often have nonspecific symptoms, and the diagnosis is often delayed. AIM: The aim of our study was to investigate the role of signal peptide-complement C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) used in the diagnosis of PE. METHODS: The study was designed prospectively. A total of 57 patients who were admitted to emergency service with clinically suspected PE were included in the study...
October 2016: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/27803753/diagnostic-implications-of-computed-tomography-pulmonary-angiography-in-patients-with-pulmonary-embolism
#16
Ayman El-Menyar, Syed Nabir, Nadeem Ahmed, Mohammad Asim, Gaby Jabbour, Hassan Al-Thani
INTRODUCTION: Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE. METHODS: A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed...
October 2016: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/27803751/suboptimal-implementation-of-diagnostic-algorithms-and-overuse-of-computed-tomography-pulmonary-angiography-in-patients-with-suspected-pulmonary-embolism
#17
Sulaiman Alhassan, Alaa Abu Sayf, Camelia Arsene, Hicham Krayem
BACKGROUND: Majority of our computed tomography-pulmonary angiography (CTPA) scans report negative findings. We hypothesized that suboptimal reliance on diagnostic algorithms contributes to apparent overuse of this test. METHODS: A retrospective review was performed on 2031 CTPA cases in a large hospital system. Investigators retrospectively calculated pretest probability (PTP). Use of CTPA was considered as inappropriate when it was ordered for patients with low PTP without checking D-dimer (DD) or following negative DD...
October 2016: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/27797317/prevalence-of-pulmonary-embolism-among-patients-hospitalized-for-syncope
#18
Paolo Prandoni, Anthonie W A Lensing, Martin H Prins, Maurizio Ciammaichella, Marica Perlati, Nicola Mumoli, Eugenio Bucherini, Adriana Visonà, Carlo Bova, Davide Imberti, Stefano Campostrini, Sofia Barbar
Background The prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients. Methods We performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay...
October 20, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27760423/endosonography-of-a-pulmonary-artery-obstruction-in-echinococcosis
#19
Mark J Schuuring, Peter I Bonta, Michele van Vugt, Frank Smithuis, Otto M van Delden, Jouke T Annema, Kees Stijnis
A 44-year-old woman with a history of pulmonary embolism and abdominal echinococcosis complained of sudden thoracic pain and shortness of breath. A D-dimer of 77.5 mg/l (reference ≤0.5 mg/l) was found. Chest CT scan revealed obstruction of the right lower and middle lobe pulmonary artery (PA). Anticoagulation therapy was initiated for the presumed diagnosis of recurrent pulmonary embolism. However, due to persistent symptoms of dyspnea, follow-up CT angiography of the chest was performed 3 months later. A persistent PA obstruction was found and the presumed diagnosis of embolism was questioned...
2016: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/27752629/pulmonary-embolism-the-diagnosis-risk-stratification-treatment-and-disposition-of-emergency-department-patients
#20
Daniel Corrigan, Christiana Prucnal, Christopher Kabrhel
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis...
September 2016: Clinical and Experimental Emergency Medicine
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