Role Of D-dimer Research Articles

Coagulation, thrombophilia and patency of arteriovenous fistula in children undergoing haemodialysis compared with healthy volunteers: a prospective analysis.

This study aimed to assess whether markers of coagulation, fibrinolysis or thrombophilia are increased in children on haemodialysis compared with controls and whether measurement of any of these factors could help to identify patients at an increased risk of arteriovenous fistula (AVF) occlusion. Blood samples were taken from 55 children immediately before a session of haemodialysis and from 20 healthy volunteers. Thrombin-antithrombin (TAT), D-dimer, plasmin-antiplasmin (PAP) and anticardiolipin immunoglobulin G (ACA-Ig G) were measured by ELISA. Factor V Leiden mutation (G1691A) was determined by gene polymorphism [restriction fragment length polymorphism (RFLP)]. Determination of the patency of the AVF was prospectively followed up for a minimum of 4 years or until the AVF was nonfunctioning. Fifty-five patients were studied with a median follow-up of 659 days (range 30-1670 days). A significant increase was found in the levels of D-dimer, PAP and ACA-Ig G in haemodialysis patients with thrombosed and nonthrombosed native AVFs vs. There was a significant difference between both chronic haemodialysis patients with thrombosed and nonthrombosed native AVF with regard to ACA-IgG levels. At 1 year follow-up, primary patency was 61.4% (27 patients). In multivariate analysis, D-dimer was inversely associated with secondary patency.Thrombophilia may predispose children with end stage renal disease to access failure. The promising finding is that in children on haemodialysis, D-dimer levels were increased and inversely correlated with secondary patency. Further evaluation is required into the possible role of D-dimer as a biomarker of AVF occlusion.

A Prospective Study of the Clinical Profile, Outcome and Evaluation of D-dimer in Cerebral Venous Thrombosis.

Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. To study various aspects of CVT and role of D-dimer. The study period was September 2012 to July 2014 and included 80 imaging proven patients of CVT. We also included 39 controls for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Discharged patients were followed up to six months. Of the total 44 were women and 36 were men (F: M=1.2:1). The mean age of the patients was 29.5±9.68 years. Most common clinical features were headache 77 (96.25%), papilloedema (67.5%) and seizures 51 (63.75%). Pregnancy was the most common cause of CVT. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity and specificity of D-dimer for diagnosing CVT was 84.62% and 80% respectively. The risk factors for poor prognosis were altered sensorium, presence of sepsis, increased sinus involvement and deep sinus thrombosis. CVT affects both sexes equally. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as a contributing factor for incidence of CVT. D-dimer is not useful in puerperal female with CVT. Positive D-dimer will strengthen the suspicion of CVT in patients with acute headache followed by a neurological deficit.

R07 - Role of D-dimer (DD) Assays in the Diagnostic Evaluation of Pulmonary Embolism (PE) in patient with cancer: a new “tailored” cut-off value for D-D, preliminary results of a mono-institutional study

R07 - Role of D-dimer (DD) Assays in the Diagnostic Evaluation of Pulmonary Embolism (PE) in patient with cancer: a new “tailored” cut-off value for D-D, preliminary results of a mono-institutional study

Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes.

The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown. Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control. Admission D-d was significantly higher in AAD (12.5±11.1 mg/L) and IMH (14.8±12.2 mg/L) compared with PAU (1.8±1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d ⩾9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival. At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

Background: Previous studies on pathophysiology suggest a role of inflammation in atherothrombotic stroke and intracardiac thrombosis in cardioembolic stroke. We explored the magnitude of D-dimer, fibrinogen and C-reactive protein (CRP) as biomarkers in acute ischemic cerebral stroke and their relation to ischemic stroke subtypes and their impact on stroke outcome after 30 days. Methods: The study was performed on 100 patients, admitted to Neurology Department, Menoufiya University, within 24 hours of acute ischemic stroke. Patients were subjected to clinical data collection, general and neurological examination, laboratory assessment (routine and biomarkers), brain computerized tomography (CT), magnetic resonance imaging (MRI), MRA, carotid and vertebrobasilar duplex and cardiac assessment. The patients were classified according to Trial of ORG 10172 in acute stroke treatment (TOAST) classification. Severity and disability were assessed by Scandinavian stroke scale and modified Rankin scale at admission and at 30 days. Results: We found that D-dimer, fibrinogen and CRP were significantly higher in patients than in controls (P < 0.001). D-dimer and fibrinogen were higher in cardioembolic stroke while CRP was higher in atherothrombotic subtype. The biomarkers were correlated significantly with the severity and disability of stroke at onset and 30 days. Conclusions: These three biomarkers in acute ischemic stroke can be considered as non-invasive tools which add important information regarding etiology and outcome. J Neurol Res. 2015;5(6):277-282 doi: http://dx.doi.org/10.14740/jnr362w

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

The Role of D-Dimer, Fibrinogen and C-Reactive Protein as Plasma Biomarkers in Acute Ischemic Stroke

D-dimer as a Prognostic Biomarker for Mortality in Chronic Obstructive Pulmonary Disease Exacerbation

BackgroundA major barrier to chronic obstructive pulmonary disease (COPD) research and management is lack of easily obtained biomarkers that are predictive of clinically important outcome measures. ObjectivesWe sought to investigate in patients admitted for acute exacerbation of COPD (AECOPD) the association of d-dimer (fibrin degradation product) obtained upon admission with in-hospital mortality and postdischarge prognosis. MethodsClinical and laboratory data were evaluated in 61 patients admitted for AECOPD in whom d-dimer levels were obtained and in whom venous thromboembolism/ pulmonary embolism was excluded. Receiver operating characteristics curve was used to determine the optimal cutoff level for d-dimer that discriminated survivors versus nonsurvivors during index hospitalization, and during follow-up that extended to a median observation period of 62.6months. ResultsMean (±SD) age of the study cohort was 71.2 ± 10.5years. Mean d-dimer level in nonsurvivors (n = 12) was significantly higher than in survivors (n = 49): 3.18 ± 0.97mg/L versus 1.45 ± 1.18mg/L, respectively, P = 0.0006. d-dimer level >1.52mg/L predicted in-hospital mortality with a sensitivity and specificity of 100% and 63.6%, respectively. After discharge, median survival of patients with d-dimer above and below 1.52mg/L were 9.6 and 62.6months, respectively (hazard ratio = 2.636; 95% confidence interval = 1.2716.426, P = 0.0111). ConclusionsElevated d-dimer is a reliable prognostic marker for both short-term and long-term survival in patients admitted for AECOPD. Prospective studies are required to further establish the appropriate role of d-dimer as a prognostic biomarker in patients with COPD.

D-Dimer Lacks Value As a Screening Tool for Venous Thrombosis but Exhibits Prognostic Power in Advanced Cancer Patients

ABSTRACT Aim: The incidence of venous thromboembolism (VTE) in advanced cancer patients is high. Analysis of D-dimer concentration serves as a screening test for VTE due to its low cost and high sensitivity, although D-dimer is frequently elevated in response to other causes, such as infection or malignancy. This study aimed to evaluate the role of D-dimer in advanced cancer patients. Methods: We retrospectively reviewed medical records of patients from July 2012 to October 2013. Incurable cancer patients exhibiting characteristics described in Well's prediction model underwent a D-dimer test at admission. Results: Among 343 incurable cancer patients, 142 patients received a Well's score ≥2 at admission. Only 4 patients (2.8%) had normal D-dimer levels ( 2.0 mg/mL. Radiologic workups were performed for 20 patients, because VTE diagnosis would not be beneficial to patients facing imminent death. These workups confirmed VTE in 8 patients (40%). The survival time was significantly differed according to D-dimer levels with a median of 48 days (95% CI, 25.9-70.1) when D-dimer levels were Conclusions: In advanced cancer patients, D-dimer concentrations may lack VTE screening power as patients without VTE also exhibited high levels of D-dimer; however, these values did exhibit prognostic power in these patients. Disclosure: All authors have declared no conflicts of interest.

The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis

BackgroundCurrent predictive severity scores for pediatric acute pancreatitis are either extrapolated from adult studies or difficult to use in practice. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity and outcome in pediatric AP. Methods36 patients (aged 1–17 yrs) with AP were included in the study. Levels of D-dimer and other routine laboratory parameters for AP were determined on admission. The Pediatric Acute Pancreatitis Severity Score was used to assess disease severity. The development of systemic and local complications was also recorded. ResultsD-dimer level was significantly higher in a group of patients with complications, median 1189.5 (271–4800) vs 172.5 (105–1086) in a group of patients without complications (p < 0.001). D-dimer showed high precision in the prediction of acute necrotic collection, with the optimal cut-off values of 442.5 μg/L, Sensitivity (Sn) 100%, Specificity (Sp) 62.1% and in the prediction of multiple organ failure with optimal cut-off value 1189 μg/L, Sn 100% and Sp 87.5%. According to the areas under the curve (AUCs) of each parameter, D-dimer seemed to have predictive power similar to PAPS score and higher than C-reactive protein and Lactate dehydrogenase level. ConclusionD-dimer level may be a simple clinical predictor of severity in pediatric acute pancreatitis.

The role of D-dimers in the diagnosis of acute aortic dissection.

Acute aortic dissection (AAD) is a life threatening cardiovascular medical emergency with a poor prognosis. To explore the utility of D-dimers (DD) in the diagnosis of AAD, we performed a prospective study and conducted a meta-analysis of previous studies. 368 suspected patients were enrolled, including AAD n = 89, PE n = 12, AMI n = 167, normal controls n = 100. All patients had a DD test immediately after admission. We then performed a comprehensive computer search to identify studies investigating using DD as a screening tool for AAD. Finally, we pooled these data to estimate sensitivity, specificity, positive and negative likelihood ratios (LRs) by using DerSimonian-Laird random-effects models. The DD concentrations in the AAD group were significantly higher than those in the AMI and normal control groups. However, the DD level of 500 ng/ml had a poor sensitivity of 51.7 % and specificity of 89.2 % in the diagnosis of AAD. Subgroup analyses found that DD only showed a well discriminative ability of distinguishing AAD patients from normal controls (specificity and positive LR was 97 % and 17.2, respectively). The pooled sensitivity, specificity, positive and negative LR in our meta-analysis was 89, 68 %, 2.71, 0.07, respectively. In conclusion, our results suggest that plasma DD levels cannot add to the certainty of AAD diagnosis and it is not a good biomarker for AAD. In the future, prospective research on patients from many parts of the world is warranted to validate our findings. In addition, different controls, methods of plasma DD assays and other factors should be considered.

Role of D-dimer in advanced cancer patients receiving end of life care.

e20504 Background: The incidence of venous thromboembolism (VTE) in advanced cancer patients is high. Analysis of D-dimer concentration serves as a screening test for VTE due to its low cost and hi...

“Role of D-Dimer in One Year Recurrence of Venous Thromboembolism after Completed Anticoagulation Treatment” Following A First Idiopathic Deep Vein Thrombosis

After oral anticoagulant therapy (OAT) withdrawal, the recurrence of risk is greatest in the first year and gradually diminishes, while the increased bleeding risk may offset the benefits of prolonged OAT. the benefits of extending anticoagulation should be balanced against the risk of bleeding . D-dimer assay and measurement of residual thrombosis on ultrasonography, so-called residual vein obstruction (RVO) were proposed to be effec- tive in selecting patients with idiopathic DVT Materials and methods: This single center prospective study was conducted in patients with a first episode of symptomatic proximal DVT, de - tected by compression ultrasonography (CUS), and who received OAT for at least 3 months. Follow-up was extended from Oct. 2011, to Aug. 2013. After enrollment, patients were re-evaluated at 1st, 6th and 12th months of their follow-up. At the first and 30-day visits, venous blood samples were taken for D-dimer test. All enrolled patients without RVT were stopped OAT. At each follow-up visit, we examined patients and inquired about health status, clinical symptoms or signs of recurrent VTE, bleeding, post-throm- botic manifestations, adherence to treatment, and concomitant analgesic or anti-inflammatory therapy. The end point outcomes were VTE recurrence or complete of this survey follow-ups. Results: A total of 68 eligible patients were enrolled. Four patients (two patients need to using long-term oral anticoagulation, and another two patients for lost to their first follow-up) were excluded. D-dimer and CUS at first was normal in 28 patients (44%) while the remaining 36 patients had abnormal D-dimer but normal CUS while both groups were not consuming their anticoagulant. Total follow-up was 52.5 patient-years. Median follow-up was 11 months (95% CI: 6-17 months). A minimum follow-up of 12 months was avail- able in 44 patients (68%). During follow-up, three recurrent events were recorded (4.6% of patients - 95% CI: 3-7%). All Recurrent events were ipsilateral DVT. Among these index cases, all had an abnormal D-dimer at either T0 and/or T1. The recurrence rate was higher in males than in females (8.6% vs. 2.2%) with an abnormal D-dimer at T0 and/or T1 with a multivariate hazard ratio of 2.1 (95% 1.2-7; p=0.04). Patients older than 65 years had a higher rate of events than younger patients (2/ 12: (16%); 95% CI: 4-24% Vs. 1/ 52: (2%); 95% CI: 0.05-3%) and hazard ratio was about 3.8; (95% CI: 1.95-8.4 p= 0.04). Patients with recurrences had higher mean D-dimer at both T0 and T1 when compared with those without recurrences but the difference was significant only for D-dimer at T1. During follow-up, two patients died (3%). Conclusion: In our cohort of DVT patients, the annual risk of recurrence with an abnormal D-dimer, either during or at one month after VKA withdrawal, was 4.6% which is much lower to the annual risk of recurrence in most studies with idiopathic and provoked VTE. The benefits of extending anticoagulation should be balanced against the risk of bleeding. So according to these results of D-Dimer assay before withdrawal of OAT, this test is helpful for OAT withdrawal decision making.

Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction

Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI. A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 μg/ml-418 ± 164 μg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003-1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000-1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 μg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 μg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity. In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.

D-dimer testing in pregnant patients: towards determining the next 'level' in the diagnosis of deep vein thrombosis.

The role of D-dimer in excluding deep vein thrombosis (DVT) in pregnancy is currently uncertain. We hypothesized that the specificity of sensitive D-dimer assays could be improved without compromising sensitivity by using higher D-dimer cut-off values. To determine the test characteristics of two rapid enzyme-linked immunosorbent assays and three latex agglutination assays in pregnancy. We recruited consecutive pregnant women who presented to participating centers with suspected DVT for the study. Symptomatic women were investigated with compression ultrasonography, and received 3 months of clinical follow-up to assess for the presence of venous thrombosis. Plasma samples for D-dimer were collected and frozen at the time of presentation. The median and mean D-dimer values for respective trimesters of pregnancy in patients with and without DVT were calculated. Receiver operating curves (ROCs) were plotted for respective assays to establish the best cut-points. The test characteristics corresponding to standard cut-points and these 'pregnancy' cut-points are presented. The prevalence of DVT in our cohort was 6.6% (95% confidence interval 4.0-10.6%). The mean and median D-dimer values were significantly increased throughout pregnancy. Overall, women with confirmed DVT had higher D-dimer levels than women without DVT (P < 0.0001). Improved specificities (62-79%) were observed with the use of higher cut-points obtained from ROCs for all five assays, and high sensitivities were maintained (80-100%) for DVT diagnosis. Using higher cut-points than those used in non-pregnant patients, the specificity of D-dimer assays for the diagnosis of DVT in pregnancy can be improved without compromising sensitivity. Validation in prospective management studies is needed.

Diagnostic issues of VTE in pregnancy

Venous thromboembolism is a major cause of maternal morbidity and mortality, and accurate diagnostic workup upon suspicion of deep vein thrombosis or pulmonary embolism in a pregnant woman is of utmost importance. The diagnostic repertoire for venous thromboembolism is, however, less well studied in pregnant women. The clinical assessment is influenced by common symptoms of pregnancy such as leg swelling or shortness of breath. The role of D-Dimer is limited, since — even during uncomplicated pregnancy — D-Dimer levels increase with gestational age. Preliminary data indicate that a normal D-Dimer in a healthy pregnant woman with a low clinical probability may exclude deep vein thrombosis. Compression ultrasonography and ventilation perfusion scanning or helical computed tomography are the imaging techniques of choice in a pregnant woman with suspected deep vein thrombosis or pulmonary embolism, respectively. The role of magnetic resonance imaging for the diagnosis of venous thromboembolism during pregnancy is uncertain and contraindications particularly to contrast media have to be considered.

D-dimer negative deep vein thrombosis in puerperium

Venous thrombo-embolism (VTE) is a major cause of morbidity and mortality during pregnancy. Most of the evidence being used in the management of this condition in pregnancy is extrapolated from the general population. One such intervention is the use of the D-dimer test for the diagnosis of thromboembolism in pregnancy. Although this test has been found to be useful in low-risk non-pregnant patients, its negative predictive value is limited in high-risk patients in the general population to be used as a reliable diagnostic tool. Considering pregnancy as a high-risk state for VTE, we have evaluated the role of D-dimer in diagnosing VTE in pregnancy and proposed a diagnostic algorithm for the management of VTE based on the current evidence available.

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction

Various diagnostic utilities have been used in the diagnosis of strangulated obstruction. Despite this, there is no simple and reliable marker for it, and diagnosis in most cases is based on clinical, laboratory, and radiological investigations. The purpose of the present study was to assess D-dimer value in the diagnosis of strangulated obstruction. A prospective study of 53 patients with small-bowel obstruction was conducted. Strangulated obstruction was present in 15 (28.3%) patients. Eight (53%) had intestinal necrosis, while 7 (47%) reversible ischemia. The blood samples were taken and analyzed with NycoCard Reader method with monoclonal antibodies specific for D-dimer neoantigens. In the presence of intestinal necrosis, there was a higher D-dimer level found than in the cases with reversible ischemia or simple small-bowel obstruction, although this difference did not reach statistically significant level. The D-dimer test had a sensitivity of 60%, specificity of 68%, positive predictive value of 43%, and negative predictive value of 81% in diagnosing strangulated obstruction. In present series, D-dimer test was neither sensitive nor specific in diagnosing strangulation.

Correction to ???Liposuction and Pulmonary Embolism: The Role of D-Dimers: Reply???

Plastic and Reconstructive Surgery: June 2007 - Volume 119 - Issue 7 - p 2348 doi: 10.1097/01.prs.0000233447.96658.00

Liposuction and Pulmonary Embolism: The Role of D-Dimers

Department of Oral and Maxillofacial Surgery, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom, [email protected] Correspondence to Dr. Varley, 32 Cinder Lane, Guilden Sutton, Chester CH3 7EN, United Kingdom, [email protected]

Liposuction and Pulmonary Embolism: The Role of D-Dimers

Liposuction and Pulmonary Embolism: The Role of D-Dimers