D-dimer Test Research Articles

Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures

ObjectiveThis study aimed to describe the characteristics of plasma D-dimer level with increasing age and establish a new age-adjusted D-dimer cutoff value for excluding preoperative lower limb deep vein thrombosis (DVT) in elderly patients with hip fractures.MethodsThis was a retrospective study of elderly patients who presented with acute hip fracture in our institution between June 2016 and June 2019. All patients underwent D-dimer test and duplex ultrasound. Patients were divided into six 5-year-apart age groups. The optimal cutoff value for each group was calculated by using receiver operating characteristic (ROC) curves, whereby the new age-adjusted D-dimer cutoff value was determined. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated and compared when different D-dimer cutoff values were applied, i.e., conventional 0.5 mg/L, previously well-established age-adjusted cutoff value (age × 0.01 mg/L) and the new age-adjusted D-dimer cutoff value herein.ResultsThere were 2759 patients included, 887 males and 1872 females, with an average age of 78 years. In total, 280 patients were diagnosed with preoperative DVT. The optimal cutoff values for the six age groups were 0.715 mg/L, 1.17 mg/L, 1.62 mg/L, 1.665 mg/L, 1.69 mg/L and 1.985 mg/L, respectively, and the calculated age-adjusted coefficient was 0.02 mg/L. With this new coefficient applied, the specificity was 61%, clearly higher than those for conventional threshold (0.5 mg/L, 37%) or previously established age-adjusted D-dimer threshold (age × 0.01 mg/L, 22%). In contrast, the sensitivity was lower than that (59% vs 85% or 77%) when D-dimer threshold of 0.5 mg/L or age-adjusted cutoff value (age × 0.01 mg/L) was used. The other indexes as PPV (15%, 11% and 12%) and NPV (93%, 93% and 94%) were comparable when three different D-dimer thresholds were applied.ConclusionsWe developed a new age-adjusted D-dimer cutoff value (age × 0.02 mg/L) for a specified high-risk population of patients aged 65 years or older with hip fractures, and demonstrated the improved utility of the D-dimer test for exclusion of DVT. This formula can be considered for use in elderly hip fracture patients who meet the applicable standards as preoperative DVT screening, after its validity is confirmed by more well-evidenced studies.

SOFA Score as a Reliable Tool to Detect High Risk for Venous Thrombosis in Patients With Critical Stage SARS-CoV-2.

Background: Severe acute respiratory syndrome from coronavirus-2 (SARS-CoV-2) has been associated with an increased risk of venous thromboembolism (VTE). Different anticoagulation protocols have been applied in several studies in the absence of clear evidence. A reliable deep venous thrombosis (DVT) indicator in critical patients with SARS-CoV-2 could guide the anticoagulation treatment; however, it has not yet been identified, and clinical applicability of the most common markers is debatable. The aim of our study was to determine the actual incidence of DVT in critically ill SARS-CoV-2 patients and to find a reliable tool to identify patients who might benefit from therapeutic-intensity anticoagulation.Methods: From March 1, 2020 to May 31, 2020, all patients admitted to the intensive care unit (ICU) for SARS-CoV-2 at Ospedale Regionale di Locarno, Locarno, Switzerland, were prospectively enrolled and screened daily with ultrasound for DVT. Following international consensus, a higher-intensity thromboprophylaxis was administered to all patients who were not at increased risk for bleeding. Sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores were calculated and time-to-DVT event in a COX proportional-hazard regression model was performed. A receiver operating characteristic (ROC) curve was used to determine sensitivity and specificity and the Youden's Index to establish the best threshold.Results: A total of 96 patients were enrolled. Deep venous thrombosis was detected in 37% of patients. Sepsis-induced coagulopathy and SOFA scores were both correlated to DVT. A SIC score of 1 vs. ≥2 showed a close association with DVT, with sensitivity, specificity, and positive and negative predictive values of 90.0, 48.1, and 49.1, and 89.7%, respectively. Most significantly though, a SOFA score of 1 or 2 points was shown to be the most accurate value in predicting the absence of DVT, indicating no need for therapeutic-intensity anticoagulation. Its sensitivity, specificity, and positive and negative predictive values were 87.9, 100, and 100, and 93.7%, respectively. The D-dimer test showed lower sensitivity and specificity whereas platelet count and aPTT were not found to be correlated to DVT.Conclusions: Patients with SOFA scores of 1 or 2 are at low risk of developing DVT and do not require therapeutic-intensity anticoagulation. Conversely, patients with scores ≥3 are at high risk of developing DVT.

TO ASSESS SAFETY OF WITHHOLDING ANTITHROMBOTIC THERAPY IN PATIENTS WITH LOW OR INTERMEDIATE PROBABILITY OF PULMONARY EMBOLISM

Background & Method: The study was carried out in the Department of Radio diagnosis, Index Medical College, Hospital & Research Centre, Indore, M.P. including 100 chronic bedridden patients with an aim to assess safety of withholding antithrombotic therapy in patients with low or intermediate probability of pulmonary embolism.
 Result: Males represented about 62% of the entire sample. Majority of male patients were in age group 50 and above. Majority (29%) of female patients were of age group of 20 to 40 yrs. On the basis of B-mode sonography and colour Doppler 20% patients were diagnosed to have acute deep vein thrombosis and 12 % patients were diagnosed to have chronic deep vein thrombosis. Out of 100 chronic bedridden patients in the study, 40% were suspected to have deep vein thrombosis on the basis of clinical signs,45% had a positive d-dimer test, 28% were positive on impedence plethysmography. 30% patients were diagnosed to have deep vein thrombosis by B mode sonography and 32% were diagnosed to have deep vein thrombosis by colour Doppler.
 Conclusion: Only 32 patients were positive for deep vein thrombosis out of 100 patients so it is safe to withhold unnecessary anticoagulation therapy in all chronic bed ridden patients because even after 3 month follow up only 1% patients were positive. Impedence plethysmography is less sensitive than ultrasonography and D-dimer test is more sensitive but it lacks specificity so ultrasound and colour Doppler is more sensitive in clinically suspected DVT patients. Ultrasonography and colour Doppler is better predictor of DVT because it is more sensitive and specific, non-invasive, painless, widely available, easy to use, less expensive, no ionizing radiation.
 Keywords: antithrombotic, pulmonary &embolism.

D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19

D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19

Performance Evaluation of the Quantitative Point-of-Care LumiraDx D-Dimer Test.

IntroductionFibrin degradation product d-dimer can be a valuable indicator for venous thromboembolism (VTE). The use of d-dimer testing in primary care settings can be limited by restricted access to laboratory services. This performance evaluation compares a quantitative, point-of-care (POC) d-dimer assay (LumiraDx d-Dimer Test) with a reference laboratory-based d-dimer assay.MethodsPlasma samples from patients presenting to secondary care in the UK, USA, and Germany were analyzed centrally using the LumiraDx d-Dimer Test and the reference test (bioMérieux VIDAS d-Dimer Exclusion II immunoassay). Method comparison used Passing–Bablok regression analysis with pre-specified equivalence criteria of r ≥ 0.9 and slope of 0.9–1.1. The NOVEL-3 study (NCT04375982) compared equivalency of fingerstick, venous blood (VB), and plasma samples from the same patient, tested at US primary care clinics next to the patient using the POC LumiraDx d-Dimer device. Measurements obtained from fingerstick and VB samples were compared with results from plasma samples, using Deming regression. The healthy reference range was determined using plasma samples of healthy volunteers, collected by commercial suppliers in Germany and the USA, which were analyzed centrally using the LumiraDx d-Dimer Test and the reference test.ResultsThe LumiraDx d-Dimer Test demonstrated agreement with the bioMérieux VIDAS d-Dimer Exclusion II immunoassay for plasma samples (r = 0.923, slope of 1.016, n = 1767). There was good agreement between fingerstick/VB samples and plasma samples (r = 0.980–0.986, n = 93) measured using the LumiraDx d-Dimer Test. Overall error rates were 1.8%. The healthy reference range 90% percentile for d-dimer was calculated as 533 µg/l fibrinogen equivalent units (FEU).ConclusionsThe quantitative LumiraDx d-Dimer Test is easy to use and can accurately measure d-dimer levels in a range of blood sample types, including fingerstick samples, which could improve assessment of VTE cases in community and hospital near-patient settings.

A Case Report on Management and Treatment of a Male Patient Suffering from Interstitial Lung Disease (ILD) or Pulmonary Disease

The present study is a case report of a man who was initially diagnosed with “interstitial lung disease” (ILD) or pulmonary disease which is supposed to be an umbrella term for a large group of disorders responsible for scattered fibrosis of the lungs. It is an irreversible scenario. The causative factors for the above mentioned diseased conditions are yet to be found, and all of them are grouped under interstitial pneumonias. The patient underwent detailed clinical investigations on several parameters such as CT pulmonary angiography, Lower limb venous Doppler, D-dimer test, Real Time polymerase chain reaction (RT PCR) for the novel SARS-CoV -2, Ultra-sonography (USG) of the abdomen, C-reactive proteins (CRP), complete blood count (CBC), Legionella antigen test, specific Mycoplasma IgM antibody assay, the total parameters of the renal functioning test of the blood serum, pro-calcitonin (PCT) level, and the acute coronary syndrome panel (POCT). After detailed investigations the patient was diagnosed with ILD and medications specific to the disease was prescribed. The medications that were prescribed were ceftriaxone with injection pantoprazole, paracetamol, levofloxacin, enoxaparin, amiodiprine, and furosemide. He was also advised to continue his own other medications along with these and contact at the emergency services of the hospital in case of any urgency. He was also advised for follow up visit. The patient responded to the applied therapeutic interventions and survived from the suffering. Thus, here a detailed case reporting has been conducted with the particular disease along with its diagnosis and management.

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation

Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020). Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367). The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected. Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, -6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, -2.0% [95% CI, -4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, -3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, -1.7% [95% CI, -5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, -1.9% to 1.8%]; P = .99). Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome. ClinicalTrials.gov Identifier: NCT02238639.

Performance of C-Reactive Protein, Procalcitonin, TAT Complex, and Factor VIII in Addition to D-Dimer in the Exclusion of Venous Thromboembolism in Primary Care Patients.

In primary care, D-dimer-combined with a clinical assessment-is recommended for ruling-out venous thromboembolism (VTE). However, D-dimer testing frequently yields false-positive results, notably in the elderly, and the search for novel biomarkers thus continues. We assessed the added diagnostic value of 4 promising laboratory tests. Plasma samples from 256 primary care patients suspected of VTE were collected. We explored added value (beyond D-dimer) of C-reactive protein (CRP), procalcitonin (PCT), thrombin-antithrombin III complex (TAT-c), and factor VIII (FVIII). Diagnostic performance of these biomarkers was assessed univariably and by estimating their area under the receiver operating curve (AUC). Added diagnostic potential beyond D-dimer testing was assessed using multivariable logistic regression. Plasma samples of 237 VTE-suspected patients were available for analysis-36 patients (25%) confirmed deep vein thrombosis, 11 patients (12%) pulmonary embolism. Apart from D-dimer, only CRP, and FVIII levels appeared to be higher in patients with VTE compared to patients without VTE. The AUCs for these 3 markers were 0.76 (95% CI: 0.69-0.84) and 0.75 (95% CI: 0.68-0.83), respectively, whereas the AUC for D-dimer was 0.90 (95% CI: 0.86-0.94). Combining these biomarkers in a multivariable logistic model with D-dimer did not improve these AUCs meaningfully. In our dataset, we were unable to demonstrate any added diagnostic performance beyond D-dimer testing of novel biomarkers in patients suspected of VTE in primary care. As such, D-dimer testing appears to remain the best choice in the exclusion of clinically suspected VTE in this setting. Netherlands Trial Register NL5974. (METC protocol number: 16-356/M; NL56475.041.16.).

Rivaroxaban versus Warfarin in the Management of Deep Venous Thrombosis

Abstract Background Deep venous thrombosis (DVT) refers to the formation of one or more blood clots in one of the body’s large veins, most commonly in the lower limbs. The clot can cause partial or complete blocking of circulation in the vein, which in some patients leads to pain, swelling, tenderness, discolouration of the skin that is warm to touch. Aim of the Work Compare the effect of direct Oral Anticoagulant (Rivaroxaban) versus Antivitamin K (warfarin) in treatment of lower limb Deep Venous Thrombosis. Patients and Methods Type of study: prospective single blinded randomized study, study setting: was conducted at Kobri Elkobba hospitals, study period: 6 months, study population: Eligible all patients above 18 years had femoropopliteal vein thrombosis, confirmed with duplex ultrasound scanning and D-dimer test and qualified under the inclusion and exclusion criteria of the study. Results Our study shows that Rivaroxaban alone is as effective as standard therapy, with similar safety, for the treatment of acute DVT and in preventing recurrence and has low risk of bleeding. There was statistically significant increase in INR monitoring during 6 months in warfarin group than Rivaroxaban group with p-value < 0.001. This because warfarin has many drug and food interaction. There's no response in treatment out come after 3 months duplex as the study was on patient of femoro popliteal DVT, however there were clinical improvement in both groups. Complete recanalization with normal augmentation by muscle compression occurred in all Rivaroxaban patients compared to 5% were partially compressible with incomplete recanalization in warfarin group after 6 months of treatment. Conclusion We concluded in patients with unprovoked VTE, rivaroxaban has the potential to reduce both the risk of major bleeding and recurrent VTE compared to warfarin. And there’s no need for adjusting the dose and INR monitoring, and Rivaroxaban has no food nor drug interactions.

299 The Diagnostic Value of D-dimer Levels for the Exclusion of Aortic Dissection

Acute aortic dissection is a highly fatal disorder if not diagnosed promptly. The current gold standard for diagnosis of aortic dissection is with CT angiogram, MRI, or transesophageal echocardiogram. These advanced imaging techniques are expensive, time-consuming, and carry risks, so they are not ideal, especially for low risk patients. A universal, rapid-screening biomarker could reduce the need for advanced imaging tests to exclude the diagnosis of acute aortic dissection. Some prior studies have suggested that serum d-dimer levels are elevated in patients with aortic dissection, but the diagnostic value of d-dimer levels for ruling out aortic dissection remains uncertain. Thus, we sought to further assess the diagnostic usefulness of d-dimer levels as a means to rule out aortic dissection in emergency department patients. This was a retrospective analysis of emergency department patients from the Hospital Corporation of America (HCA) database. We queried the database to find patients who had a diagnosis of acute aortic dissection and who had a d-dimer test result within 24 hours of arrival to the emergency department. We also identified patients who had a diagnosis of (nonspecific) chest pain and who had a d-dimer test result within 24 hours of arrival to the emergency department. The median d-dimer value was compared in the aortic dissection group and the chest pain group using the Wilcoxon Rank Sum Test. We determined the sensitivity and specificity of d-dimer for aortic dissection using the standard cutoff value of 500 ng/mL, and we formulated a receiver operating characteristic (ROC) curve. Finally, we sought to determine if there is a different d-dimer cutoff value with better test characteristics than the standard 500 ng/mL. D-dimer values are reported in fibrinogen equivalent units (FEUs). A total of 48,902 patients’ records were analyzed for this study. This sample included 572 aortic dissection patients and 48,330 chest pain patients. The median d-dimer value for the aortic dissection group was 2455 ng/mL, and for the chest pain group, it was 385 ng/mL. The difference between the median values of each group of 2070 ng/mL was statistically significant (p-value <0.0001). Using a standard cutoff of 500 ng/mL, we found the sensitivity of the d-dimer to be 91.1% and the specificity to be 71.4%. To achieve a sensitivity greater than 95% for aortic dissection, the d-dimer cutoff had to be reduced to 375 ng/mL, at which point the sensitivity was 95.1% and the specificity was 48.5%. The Youden index maximized at 835 ng/mL, at which point the sensitivity was 82.9% and the specificity was 86.3%. The area under the ROC curve was 0.91 (95% CI 0.89 to 0.92). In general, serum d-dimer values are higher in patients with an aortic dissection than in those with nonspecific chest pain. At the standard cutoff of 500 ng/mL, the serum d-dimer seems to have a high sensitivity for aortic dissection, but it is likely not high enough such that d-dimer levels alone can be used to exclude aortic dissection.

EVALUATION OF SCIENTIFIC AWARENESS OF MEDICAL FACULTY STUDENTS ABOUT COVID-19

Purpose: In the COVID-19 pandemic, a large number of physicians were needed. In order to meet possible physician needs, medical students should also be knowledgeable. The purpose of our study is to evaluate the awareness of different classes in our faculty about COVID-19.Material and Methods: This study is a multiple-choice questionnaire directed to students via a google form. In the first part, there are demographic questions, whether the student or a relative has had the disease, and in the second part, laboratory findings and questions about the diagnosis.Results: 334 students answered, and Croncbachs'Alpha (α) coefficient was 0.552 with 55% sample success. When the answers were analyzed according to the grades of the students, a significant difference was found between grade 2 and other grades (p&lt;0.05). In all classes; The answer to the question "I do not agree" to the question "The most commonly used imaging method is computed tomography" is high. The question of where to get the swab sample is usually answered correctly, but the answer of "I have no idea" is high in 2nd graders. To the question of 'The primary target organ of Covid is the liver', the 2nd, 3rd grades gave a positive answer with a rate of 9.6%, 12%, and 14.7%, respectively. The questions of "use of D-dimer test" and "measurement of antibodies in serum" in the follow-up of the disease were mostly answered as "I have no idea" by the 2nd and 3rd grades.Conclusion: COVID-19 is not over yet and medical students need to be able to answer the questions posed to them by the society at different stages of the disease and follow-up period and make the right guidance. Especially the number of students who state that they have no idea about the imaging method and laboratory analysis questions is high. Additional courses on the subjects of pandemic management, filiation, diagnosis-follow up-treatment can be added to the curriculum of all classes in our medical faculty.

New cut-off point for D-dimer in the diagnosis of pulmonary embolism during pregnancy.

BackgroundConsidering that pulmonary embolism (PE) is one of the leading causes of mortality among pregnant women and that the D-dimer level in pregnancy can be highly fluctuating, a new and reliable D-dimer reference value is essential to identifying PE in this group of patients. Hence, the present study aimed to evaluate the diagnostic effect of D-dimer testing in pregnant women with suspected PE.MethodsThis study recruited 100 women with confirmed pregnancy or six weeks after delivery or abortion with suspected PE symptoms. Wells criteria, D-dimer values, and pregnancy trimesters were recorded. Definitive PE results were obtained using multidetector computed tomography (MDCT) or pulmonary ventilation/perfusion scans.ResultsD-dimer cut-off point in PE diagnosis was higher than 1,447 mg/L [sensitivity, 87.5%; specificity, 63.04%; area under the curve (AUC)=0.735; P=0.003]. In addition, the combination of Wells criteria with the D-dimer test indicated that the cut-off points of D-dimer in PE likely and unlikely women were 1,962 and 1,447 mg/L, respectively, and had acceptable and significant diagnostic value in PE detection. In addition, the diagnostic value of D-dimer in pregnancy trimesters was not found to be significant (P>0.05).ConclusionThe new cut-off points of 1,447 and 1,962 mg/L were determined for D-dimer in pregnant women with likely and unlikely PE, respectively. Moreover, the new cut-off points in the first and second trimesters of pregnancy were 1,701 mg/L and 1,451 mg/L, respectively, which indicated no statistically acceptable diagnostic value.

Wells Clinical Probability and D-dimer Testing: Risk Stratification for Acute Lower Extremity Deep Vein Thrombosis

Current vascular guidelines recommend duplex ultrasound (DUS) to rule out acute lower extremity deep vein thrombosis (DVT). The combined use of D-dimer levels with Wells clinical probability scores has been proposed as an alternative method to exclude DVT and minimize the use of DUS in low-risk patients. We hypothesized that high-risk patients who would benefit from further evaluation for DVT with DUS can be reliably identified using a combination of the plasma D-dimer level and Wells score. A prospective observational study was performed. Outpatients presenting to the emergency department with a chief complaint concerning for acute lower extremity DVT underwent risk stratification into three groups on the basis of pretest probability using the Wells score and plasma D-dimer level. All patients were evaluated with whole leg ultrasound to the confirm diagnosis. Of 3087 patients, 74.2% were classified as low risk, 18.6% as moderate risk, and 7.2% as high risk. The prevalence of DVT was 7.3% on completion of DUS. The negative predictive value for a negative D-dimer level and negative Wells score was 99.8%. A positive D-dimer level with a positive Wells score had a sensitivity and specificity of 97.4% and 91.9% for DVT, respectively. The plasma D-dimer levels correlated with the DVT level (η2 = 0.22) and were highest in those with proximal DVT. The combined use of the Wells clinical probability score and plasma D-dimer level is a safe and effective method of risk stratifying emergency room patients with lower extremity symptoms concerning for acute DVT. Patients with a low probability Wells score and negative plasma D-dimer level are unlikely to benefit from DUS, and patients with a positive D-dimer level and Wells score would benefit from whole leg DUS to rule out high-risk thrombi.

Assess predictive values of a binary diagnostic test under a nested case–control design

ABSTRACT Predictive values of a binary diagnostic test are often evaluated under a random sample design. When the disease is rare, however, such a design might not be as efficient as a nested case–control design where the cases are oversampled from a large existing cohort. Under a nested case–control design, direct proportion estimators of predictive values are biased because cases are oversampled. Consistent estimates of predictive values can be easily obtained by inverse probability weighting (IPW) method. The only difficulty with these IPW estimators has been the absence of expressions for their variances. To fill this gap, in the current paper, we obtain the asymptotic variance formulas for the IPW estimators of predictive values. Unlike their counterparts from weighted logistic regression, our variance formulas take into account the variance of the estimated weights in the IPW estimators of predictive values. We further use the proposed variance formulas to examine the gain in efficiency under a nested case–control design compared with a simple random sampling design. Our results clearly show that when the disease is rare, a nested case–control design can achieve a substantial amount of variance reduction by oversampling cases, compared with a random sample design. Finally, we compare via simulation the accuracy of the proposed variance formulas with the existing methods and illustrate the proposed method by a real data example evaluating the accuracy of D-dimer test.

History of COVID-19 infection is not associated with increased D-dimer levels and risk of deep-vein thrombosis in total joint arthroplasty.

IntroductionIn the acute phase of COVID-19, elevated d-dimer levels indicate a hypercoagulable state putting the patients at increased risk for venous thromboembolic disease (VTE). It is unclear, if prior COVID-19 disease increases the risk for VTE after total joint arthroplasty (TJA) and if d-dimer levels can be used to identify patients at risk.Materials and methodsd-Dimer levels of 313 consecutive SARS-CoV-2 IgG-positive and 2,053 -negative patients undergoing TJA between 05/20 and 12/20 were evaluated. d-Dimer levels were divided into three groups: < 200 ng/ml, 200–400 ng/ml, and > 400 ng/ml d-dimer units (DDU). 277 SARS-CoV-2 IgG-positive patients underwent a Doppler ultrasound to rule out deep-vein thrombosis (DVT) 4–6 weeks after TJA.Resultsd-Dimer levels did not differ significantly between SARS-CoV-2 IgG-positive and -negative patients (p value 0.53). Among SARS-CoV-2 IgG-negative patients, 1687 (82.17%) had d-dimer levels < 200 ng/ml, 256 (12.47%) between 200 and 400 ng/ml, and 110 (5.36%) > 400 ng/ml. Of the SARS-CoV-2 IgG-positive patients, 257 (83.71%) had d-dimer levels < 200 ng/ml, 34 (11.07%) between 200 and 400 ng/ml, and 16 (5.21%) > 400 ng/ml. A postoperative DVT was detected in nine patients (2.9%) in the SARS-CoV-2 IgG-positive group and a PE in one patient (0.3%). 7/229 patients with < 200 ng/ml (3.1%), 1/28 patients (3.6%) with 200–400 ng/ml and 1/9 patients (11.1%) with d-dimer levels > 400 ng/ml had a DVT or PE (p = 0.43).ConclusionsThe findings of this investigation suggest there is no difference in d-dimer levels between SARS-CoV-2 IgG-positive and -negative patients undergoing TJA. Although there is a trend for increased VTE rates with increased d-dimer levels, routine d-dimer testing is not recommended based on the current data. SARS-CoV-2 IgG-positive patients have a low risk of VTE in the current study.

CT pulmonary angiography appropriateness in a single emergency department: does the use of revised Geneva score matter?

PurposeTo assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE).Material and methodsBetween November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded.ResultsIn total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings.ConclusionThe study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.

Initial reports of the SARS-CoV-2 Delta variant (B.1.617.2 lineage) in Bangladeshi patients: Risks of cross-border transmission from India.

Initial reports of the SARS-CoV-2 Delta variant (B.1.617.2 lineage) in Bangladeshi patients: Risks of cross-border transmission from India.

Pengaruh Range Of Motion (ROM) Angkle Terhadap Resiko Deep Vein Thrombosis (DVT) Pada Pasien Diabetes Mellitus Dengan Luka Ulkus: Literature Review

Background: Diabetes Mellitus (DM) is the most chronic disease throughout the world which is a chronic metabolic disease due to pancreas that cannot produce enough insulin and the body cannot use effective insulin, as evidenced by the number of diabetes mellitus prevalence that can continue at any time increased. Diabetes mellitus is a metabolic disease which is very high risk of death. Patients with diabetes mellitus participate with thrombosis in blood vessels, one of which is diabetic foot ulcer. Thrombosis in patients with diabetic foot ulcers will increase thrombosis in the lower limbs that are part of venous thromboembolism, or Deep Vein Thrombosis (DVT). One effort to repair the wound can be done with practice. Exercise is one of the first management strategies proposed for new patients diagnosed with diabetes, because along with diet and policy modifications, exercise and exercise are important components of all diabetes intervention programs, which by doing exercises can help very much.Research Objectives: This literature review discusses the causes of deep venous thrombosis (DVT), causes of ulcer wounds and looks for the influence of the Angkle range of motion (ROM) on the risk of Deep Vein Thromosis (DVT) in patients with diabetes mellitus with ulcer wounds.Method: The literature database search method was conducted at Google Scholar and Pubmed. The literature used is literature that meets the inclusion criteria and published the last five years, is approved then selected and reviewed.Results: Final results There are 4 literatures that can be reviewed. Based on the literature conclusions, it can be found several exercises in patients with diabetes mellitus so as to increase diabetes, and can reduce the need for Deep Vein Thromosis (DVT). To find out the risk of Deep Vein thrombosis (DVT) can be determined by the D-Dimer test. If the D-Dimer test shows positive results, then the patient must use DVT

A simple scoring system in COVID-19 patients with neurological manifestations

Background: Coronavirus disease 2019 (COVID-19) has affected a rapidly growing patient population worldwide. To effectively manage the disease, physicians need tests or methods that classify patients according to their risks. Our aim is to determine the importance of mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), MPVNLR score (MPV×Neutrophil/lymphocyte) in predicting the clinical course and mortality in hospitalized COVID-19 patients with neurological manifestations. Methods: A total of 300 patients were enrolled in the study. MPV, NLR, MPVNLR score, CRP, D-dimer, IL-6, and procalcitonin tests were obtained for each patient. Results: MPV, NLR, MPVNLR score, IL-6, D-dimer, procalcitonin, and CRP in the non-survivor group were higher than the survivor group (p=0.001, p:0.001, p=0.001, p=0.001, p=0.001, p=0.027, and p=0.001, respectively). MPV, NLR, MPVNLR score, IL-6, D-dimer, procalcitonin and CRP were higher in patients with altered mental status (p=0.001, p=0.001, p=0.001, p=0.014, p=0.002, p=0.026, and p=0.001, respectively). Conclusion: High MPV, NLR, and MPVNLR scores may be simple markers to predict mortality and mental deterioration in COVID-19.

Impact of routine preoperative sonographic screening with early intervention for deep venous thrombosis in lower extremities on preventing postoperative venous thromboembolism inpatients with gastric cancer scheduled for minimally invasive surgery.

This study aimed to investigate the clinical efficacy of lower-extremity ultrasonography screening with early intervention for deep venous thrombosis (DVT) on the incidence of venous thromboembolism (VTE) after minimally invasive surgery (MIS) for gastric cancer (GC). Between January 2012 and December 2019, 1070 patients were diagnosed with both clinical and pathological stage I-III GC and underwent MIS at our institution. Routine ultrasonographic screening for DVT in lower extremities is performed before MIS. Patients diagnosed with DVT were preoperatively administered anticoagulant therapy. Enoxaparin was routinely administrated after surgery irrespective of the presence of DVT. The incidence of postoperative symptomatic VTE was examined retrospectively. A total of 74 (6.9%) patients were preoperatively diagnosed with DVT. Multivariate analyses revealed that age > 70years (p = 0.015), female sex (p < 0.001), and positive serum D-dimer test (p < 0.001) were significant and independent risk factors for preoperative DVT. The incidence of symptomatic postoperative VTE was 1 (0.09%); symptomatic VTE developed in one patient among patients without DVT, whereas no patient with DVT developed VTE. Preoperative DVT screening using lower-extremity ultrasonography followed by preoperative anticoagulant therapy should be considered as a useful strategy to safely perform MIS for GC without increasing the incidence of VTE.