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d dimer for pulmonary embolism

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https://www.readbyqxmd.com/read/27913507/diagnosis-of-suspected-venous-thromboembolism
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/27742261/predictors-and-causes-of-long-term-mortality-in-elderly-patients-with-acute-venous-thromboembolism-a-prospective-cohort-study
#10
Nicolas Faller, Andreas Limacher, Marie Méan, Marc Righini, Markus Aschwanden, Jürg Hans Beer, Beat Frauchiger, Josef Osterwalder, Nils Kucher, Bernhard Lämmle, Jacques Cornuz, Anne Angelillo-Scherrer, Christian M Matter, Marc Husmann, Martin Banyai, Daniel Staub, Lucia Mazzolai, Olivier Hugli, Nicolas Rodondi, Drahomir Aujesky
BACKGROUND: Long-term predictors and causes of death are understudied in elderly patients with acute venous thromboembolism. METHODS: We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was overall mortality. We explored the association between patient baseline characteristics and mortality, adjusting for other baseline variables and periods of anticoagulation as a time-varying covariate...
October 11, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27720540/best-clinical-practice-current-controversies-in-pulmonary-embolism-imaging-and-treatment-of-subsegmental-thromboembolic-disease
#11
Brit Long, Alex Koyfman
BACKGROUND: Pulmonary embolism (PE) affects >600,000 patients per year in the United States. Evaluation includes clinical decision rules, laboratory tests, and several imaging modalities. The diagnosis of PE has risen in recent years, particularly subsegmental PE (SSPE). Controversy exists concerning the diagnosis and treatment of these lesions. OBJECTIVE: We sought to provide emergency physicians with a review of the controversies surrounding PE testing and the diagnosis and treatment of SSPE...
October 6, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27717576/optimizing-ct-pulmonary-angiogram-utilization-in-a-community-emergency-department-a-pre-and-postintervention-study
#12
Michael T Booker, John O Johnson
PURPOSE: Optimizing the utilization of CT pulmonary angiogram (CTPA) for the diagnosis and workup of acute chest pain can provide an opportunity to reduce unnecessary radiation and health care system expense. METHODS: An attempt to improve CTPA utilization began by measuring overall department and clinician-specific utilization. This was bolstered by retrospectively evaluating patient charts for pulmonary embolism scoring criteria and D-dimer utilization so as to better understand gaps in diagnostic workup...
October 4, 2016: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27689922/yield-of-ct-pulmonary-angiography-in-the-emergency-department-when-providers-override-evidence-based-clinical-decision-support
#13
Zihao Yan, Ivan K Ip, Ali S Raja, Anurag Gupta, Joshua M Kosowsky, Ramin Khorasani
Purpose To determine the frequency of, and yield after, provider overrides of evidence-based clinical decision support (CDS) for ordering computed tomographic (CT) pulmonary angiography in the emergency department (ED). Materials and Methods This HIPAA-compliant, institutional review board-approved study was performed at a tertiary care, academic medical center ED with approximately 60 000 annual visits and included all patients who were suspected of having pulmonary embolism (PE) and who underwent CT pulmonary angiography between January 1, 2011, and August 31, 2013...
September 30, 2016: Radiology
https://www.readbyqxmd.com/read/27661781/questioning-the-use-of-an-age-adjusted-d-dimer-threshold-to-exclude-venous-thromboembolism-analysis-of-individual-patient-data-from-two-diagnostic-studies-reply
#14
S Takach Lapner, Jim A Julian, Lori-Ann Linkins, Shannon Bates, Clive Kearon
Pernod and colleagues used data from the DIET study to compare, among patients with suspected pulmonary embolism (PE), the proportion with a negative D-dimer result with age-adjusted D-dimer interpretation versus using a D-dimer threshold of 500μg/L. A negative D-dimer results was not obtained more often with age-adjusted interpretation and, therefore, they concluded that age-adjusted D-dimer interpretation is inappropriate. While our analysis also did not support the use of age-adjusted D-dimer interpretation in the evaluation of patients with suspected venous thromboembolism (VTE), we came to this conclusion for different reasons than Pernod and colleagues...
September 23, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27614231/yield-of-computed-tomography-pulmonary-angiogram-in-the-emergency-department-in-cancer-patients-suspected-to-have-pulmonary-embolism
#15
Pierre Tannous, Zubin Mukadam, Chetan Kammari, Harsha Banavasi, Ayman O Soubani
OBJECTIVE/BACKGROUND: The use of computed tomography pulmonary angiography (CTPA) in the emergency department (ED) for patients suspected to have pulmonary embolism (PE) has been steadily rising in the last 2decades. However, there are limited studies that specifically address the use of CTPA in the ED for cancer patients suspected to have PE. The objective of this study is to assess the rate of positive PE by CTPA in the ED in cancer patients and the variables that are associated with positive results...
December 2016: Hematology/oncology and Stem Cell Therapy
https://www.readbyqxmd.com/read/27567411/detection-of-pulmonary-embolism-in-high-risk-children
#16
Kara E Hennelly, Marc N Baskin, Michael C Monuteuax, Joel Hudgins, Eugene Kua, Ashlee Commeree, Rotem Kimia, Edward Y Lee, Amir Kimia, Mark I Neuman
OBJECTIVE: To evaluate 2 commonly used adult-based pulmonary embolism (PE) algorithms in pediatric patients and to derive a pediatric-specific clinical decision rule to evaluate children at risk for PE, given the paucity of data to guide diagnostic imaging in children for whom PE is suspected. STUDY DESIGN: We performed a single-center retrospective study among 561 children <22 years of age undergoing either D-dimer testing or radiologic evaluation (computed tomography or ventilation-perfusion scan) in the emergency department setting for concern of PE...
November 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/27556937/pathogenesis-diagnosis-and-treatment-of-venous-thromboembolism-in-older-adults
#17
Stacy A Johnson, G Paul Eleazer, Matthew T Rondina
Older adults have a significantly greater risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, than younger adults. The cause of this greater risk is thought to be multifactorial, including age-related changes in hemostatic factors and greater comorbid conditions and hospitalizations, but is not completely understood. Moreover, VTE remains underrecognized in older adults and may present atypically. Thus, a low index of clinical suspicion is essential when evaluating older adults with possible VTE...
September 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27494075/d-dimer-test-for-excluding-the-diagnosis-of-pulmonary-embolism
#18
REVIEW
Fay Crawford, Alina Andras, Karen Welch, Karen Sheares, David Keeling, Francesca M Chappell
BACKGROUND: Pulmonary embolism (PE) can occur when a thrombus (blood clot) travels through the veins and lodges in the arteries of the lungs, producing an obstruction. People who are thought to be at risk include those with cancer, people who have had a recent surgical procedure or have experienced long periods of immobilisation and women who are pregnant. The clinical presentation can vary, but unexplained respiratory symptoms such as difficulty breathing, chest pain and an increased respiratory rate are common...
August 5, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27455821/positive-pulmonary-computed-tomography-angiography-in-patients-with-suspected-acute-pulmonary-embolism-clinical-prediction-rules-thromboembolic-risk-factors-and-implications-for-appropriate-use
#19
Thanawat Vongchaiudomchoke, Thananya Boonyasirinant
BACKGROUND: Acute pulmonary embolism (PE) is associated with a variety of non-specific clinical manifestations. Using diagnostic algorithms that are based on internationally recognized guidelines, pulmonary computed tomography angiography (CTA) serves as the gold standard diagnostic imaging tool in PE. However; inappropriate use of pulmonary CTA may lead to unnecessary radiation exposure, contrast exposure, and cost. Based on our review of the literature, there is no existing data regarding prevalence and appropriate use of pulmonary CTA in suspected acute PE in Thailand...
January 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
https://www.readbyqxmd.com/read/27455175/questioning-the-use-of-an-age-adjusted-d-dimer-threshold-to-exclude-venous-thromboembolism-analysis-of-individual-patient-data-from-two-diagnostic-studies
#20
S Takach Lapner, J A Julian, L-A Linkins, S M Bates, C Kearon
Essentials It is unclear if raising the D-dimer level to exclude venous thrombosis in older patients is valid. We compared this 'age-adjusted' strategy with other ways of interpreting D-dimer results. A non-age adjusted increase, and using higher thresholds in younger patients, was just as accurate. Age-adjustment of D-dimer thresholds does not appear to be appropriate. Click to hear Prof. le Gal's presentation on controversies in venous thromboembolism diagnosis SUMMARY: Background Using a progressively higher D-dimer level to exclude venous thromboembolism (VTE) with increasing age has been proposed but is not well validated...
October 2016: Journal of Thrombosis and Haemostasis: JTH
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