Significant Difference In D-dimer Levels Research Articles

Values of Caprini Risk Assessment Scale and D-Dimer for Predicting Venous Thromboembolism During Puerperium.

To evaluate the predictive value of the combination of the Caprini risk assessment model (RAM) and D-dimer for venous thromboembolism (VTE) during puerperium. This was a retrospective case-control study. Thirty-one puerperium patients with VTE were included as cases, and 279 puerperium women without VTE were matched to cases according to age, number of fetuses, birth day and delivery mode at the ratio of 9:1. Demographic data, clinical data and laboratory parameters within postpartum 24 h were collected. Multivariate analysis, employing the forward stepwise model, was conducted to identify independent factors associated with VTE during puerperium. The predictive values of Caprini RAM, D-dimer and their combination were evaluated using receiver operating characteristic (ROC) curve, and the area under curve (AUC) was compared using Z test. Univariate analysis demonstrated that there were significant differences in D-dimer levels, Caprini score, scarred uterus, adherent placenta, postpartum hemorrhage and intrauterine infection between cases and controls (P<0.05). Multivariate analysis demonstrated that D-dimer levels (OR: 1.754, 95% CI: 1.237-3.182), Caprini score (OR: 1.209, 95% CI: 1.058-2.280), scarred uterus (OR: 1.978, 95% CI: 1.258-3.794), postpartum hemorrhage (OR: 2.276, 95% CI: 1.334-4.347) and intrauterine infection (OR: 2.575, 95% CI: 1.463-4.618) were independently associated with VTE during puerperium with adjustment for adherent placenta and fetal birth weight. The AUCs of D-dimer levels, Caprini score and their combination were 0.748 (SE: 0.030, 95% CI: 0.688-0.807), 0.647 (SE: 0.035, 95% CI: 0.578-0.716) and 0.840 (SE: 0.025, 95% CI: 0.791-0.888). Combination prediction had a higher AUC compared with that of independent prediction (0.840 vs 0.748, Z=2.356, P=0.009; 0.840 vs 0.647, Z=4.487, P<0.001) with a sensitivity of 83.9% and specificity of 80.3%. The combination of the Caprini RAM and D-dimer could significantly elevate the predictive value for VTE during puerperium, and this new tool had the potential in the prediction of VTE during puerperium.

Relationship between D-dimer level and severity in COVID-19 cases at Dustira Hospital

Coronavirus Disease-2019 (COVID-19) is an emerging disease with clinical symptoms similar to severe pneumonia. It is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 encompasses various degrees of severity, including mild, moderate, severe, and critical. One of the supporting tests used to detect COVID-19 is the D-dimer test. This cross-sectional study aims to investigate the relationship between D-dimer levels and the severity of COVID-19. The study was conducted at Dustira Hospital in West Java, Indonesia, from September 2022 to January 2023. D-dimer examination utilizes the Sysmex CS-2500 instrument, with a reference value of &lt;0.5 mg/L. A sample of 42 patients was selected using the purposive sampling technique. The results revealed that the majority of confirmed COVID-19 cases were female (59.5%), with the highest proportion in the age groups of 41-50 years and 51-60 years (33.3%). Among the patients, 52.4% had moderate severity, and 64.3% had increased D-dimer levels. The average D-dimer levels in patients with moderate, severe, and critical symptoms were 0.97 mg/L, 2.33 mg/L, and 4.35 mg/L, respectively. The data were analyzed using the Kruskal-Wallis test, which indicated a significant difference in D-dimer levels based on the severity of COVID-19 (p=0.0001). Elevated D-dimer levels occur as a result of SARS-CoV-2 infection, which triggers an exaggerated inflammatory response leading to a cytokine storm. This, in turn, causes endothelial cell dysfunction and stimulates an excessive immune response, resulting in immune cells attacking healthy tissue. The severity of symptoms worsens as the D-dimer level increases.

Effect of domestic COVID-19 vaccine on the plasma D-dimer levels of early pregnant women in China.

To investigate the effect of COVID-19 vaccination on plasma D-dimer levels in early pregnant women. A total of 834 early pregnant women(gestational age ≤ 13 weeks), who visited Northwest Women and Children's Hospital between December 2020 and April 2022, were selected. There were 696 women in the healthy group (group A) and 138 in the group with a history of adverse pregnancy and childbirth (group B). The plasma D-dimer levels of all participants were tested, and the COVID-19 vaccine history of all participants was collected using a survey questionnaire. The plasma D-dimer levels did not differ between group A and the group B (p = 0.1327). In the group A, 470 were vaccinated and 226 were unvaccinated. The D-dimer levels of vaccinated individuals were lower than those of unvaccinated individuals (p = 0.0047). In the group B, 84 were vaccinated and 54 were unvaccinated; no difference in D-dimer levels was found between the vaccinated and unvaccinated individuals (p = 0.0542). In the group A, the D-dimer levels of the unvaccinated group were not different from those of women vaccinated with one dose (p = 0.208), but they were higher than those who received two doses (p = 0.019) or three doses (p = 0.003). And, no significant difference in D-dimer levels was found among women who received different vaccine brands and with different vaccination times. This study preliminarily indicates that COVID-19 vaccination does not increase D-dimer levels in early pregnant women.

Correlation of serum D-dimer level and the event microvessel cardiac thrombosis observed on core biopsy in post mortem COVID-19 Patients in Dr. Soetomo Hospital Surabaya, Indonesia

Link of Video Abstract: https://youtu.be/ivpwfj9PxWQ Background: Microvascular coronary thrombosis is an emerging risk factor that worsens the prognosis of COVID-19 patients. This study aims to show for the first time a descriptive of histopathologic findings from post-mortem COVID-19 patients and to analyze whether D-Dimer serum level, a marker of hyper-coagulopathy, correlates with coronary microvascular thrombosis from the cardiac core biopsy. Method: This was an observational analytic study with a retrospective cohort design from July-December 2020. Cardiac core biopsy was taken from patients who died while treated at the isolation ICU at Dr. Soetomo due to severe COVID-19. The samples were taken in 1-hour post-mortem and then analyzed histopathologically with Hematoxylin-eosin staining under a light microscope to evaluate the presence of coronary microvascular thrombosis and other pathological findings from the cardiac biopsy. Clinical information and D-Dimer levels from medical records and analyzed for coronary microvascular thrombosis using Man-Whitney and C-statistic analysis using SPSS 22 software. Result: There were 39 samples of post-mortem patients in this study. The majority were men (71.8%), with a mean age of 48.9 years old. Focal microvessel coronary thrombosis was found in 28%). The median D-Dimer level was increased from the average baseline (3460 mg/dl). However, there was no significant difference in D-dimer levels between focal microvessel coronary thrombosis incidents (p-value 0.827, C statistic AUC 0.523). The lack of focal necrosis in the surrounding tissue suggests that the thrombosis resulted from proximal embolization to distal capillary coronary, which already happened before, rather than the primary in-situ process in microvascular, hence may explain why D-Dimer was not correlated with the finding of coronary microvascular thrombosis in this study. Conclusion: D-dimer serum levels were not associated with focal microvessel thrombi in post-mortem COVID-19 patients. This result supports previous studies that showed D-Dimer was not specific to detect thrombosis in microvascular.

D-dimer measurement is useful irrespective of time from the onset of acute aortic syndrome symptoms

BackgroundIn acute aortic syndrome (AAS) screening, D-dimer is a well-established biomarker whose usefulness has been scarcely studied with respect to its measurement timing. We aimed to evaluate the effectiveness of D-dimer-based AAS screening focused on the time interval between AAS onset and D-dimer measurement. MethodsWe retrospectively analyzed consecutive patients diagnosed with AAS who visited our hospital between 2011 and 2021. For the primary analysis, we divided patients according to the quartiles of the time interval between AAS symptom onset and D-dimer measurement. D-dimer level ≥ 0.5 μg/mL and age-adjusted D-dimer ≥ [age (years) × 0.01] μg/mL (minimum of 0.5 μg/mL) were defined as positive. The primary endpoint was the comparative ability of D-dimer to detect AAS within and between each time quartile. In an exploratory secondary analysis, we reported patient and AAS characteristics in the subgroup of patients who underwent repeat D-dimer measurement within 48 h of the first D-dimer measure. ResultsThe 273 AAS patients were divided into four groups based on quartiles of the time interval (Group 1, ≤1 h; Group 2, 1–2 h; Group 3, 2–5 h; and Group 4, >5 h). There were no significant differences in D-dimer levels or in the proportions with positive D-dimer (Group 1: 97%, Group 2: 96%, Group 3: 99%, Group 4: 99%; P = 0.76) or positive age-adjusted D-dimer (Group 1: 96%, Group 2: 90%, Group 3: 96%, Group 4: 97%; P = 0.32) between the groups. Of the 147 patients who had D-dimer re-measured, nine had negative D-dimer levels on either the primary or secondary measurement. Of these nine patients, eight had AAS with a thrombosed false lumen and one with a patent false lumen had a short length of dissection. In all nine patients, D-dimer levels remained low (maximum of 1.4 μg/mL). ConclusionD-dimer levels were elevated from the early stages of AAS. The clinical utility of D-dimer is not affected by the time interval from AAS onset to D-dimer measurement, but rather is influenced by AAS characteristics.

D-dimer as a Potential Biomarker of Severity in Children Confirmed with COVID-19

Background: Coronavirus disease 2019 (COVID-19) in children spreads easily and has a relatively high incidence. Severe complications in children confirmed with COVID-19 are thought to be related to the multisystem inflammatory syndrome, which is associated with coagulation disorders. D-dimer is a fibrin degradation end product which is easy to examine, affordable, fast and reliable. This study investigated the potency of D-dimer levels as a biomarker and assessed optimal cut-off value of D-dimer on severity of COVID-19 in children. Materials and methods: An analytical observational study with a cross-sectional design was conducted in children aged 1-18 years confirmed to have mild, moderate or severe COVID-19 who were treated in the isolation room of Dr. Moewardi Hospital, Surakarta, Indonesia from September 2021 to February 2022. Statistical analysis was conducted using Mann- Whitney test and p&lt;0.05 was considered as statistically significant. The cut-off value of D-dimer was determined with the receiver operating characteristic (ROC) curve. Results: There were 39 children with COVID-19. They were in mild (n=14; 35.9%), moderate (n=19; 48.7%) and severe (n= 6; 15.4%) stages. There were significant differences in D-dimer levels between mild and moderate stages (p=0.001), and mild and severe stages (p=0.001). No significant difference in D-dimer levels between moderate and severe stages (p=0.162). The cut-off value of D-dimer was 485 μg/mL with 92% sensitivity and 71.4% specificity. Conclusion: D-dimer can be used as a potential biomarker of severity in children with COVID-19.Keywords: D-dimer, COVID-19, severity, children

Analysis of characteristics of the location of lower extremity deep vein thrombosis and the site of pulmonary embolism in hospitalized patients

To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis (DVT) and the site of pulmonary embolism in hospitalized patients. The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively. According to the location of lower extremity DVT, the patients were divided into mixed DVT, proximal DVT, and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis. Mixed DVT was referred to the presence of both proximal and distal DVT. According to the involved site of pulmonary artery, pulmonary embolism was divided into three types: main pulmonary artery, left or right pulmonary artery trunk embolism, lobar pulmonary artery embolism and segmental pulmonary artery embolism. The location of lower extremity DVT, the site of pulmonary embolism, the clinical manifestation (shortness of breath, chest tightness, chest pain, hemoptysis, cough, lower limb swelling, lower limb pain, syncope, fever) and risk factors (fracture/trauma, tumor, diabetes, hypertension, atrial fibrillation, infection, surgery, autoimmune diseases, paralysis, pregnancy) of venous thromboembolism (VTE), and the level of D-dimer were analyzed. A total of 209 patients were enrolled finally, including 127 patients with left lower extremity DVT (60.8%) and 82 with right lower extremity DVT (39.2%). Mixed DVT accounted for 39.2%, proximal DVT accounted for 17.3%, and distal DVT accounted for 43.5% (anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%, calf muscular venous thrombosis accounted for 28.7%). The incidences of main pulmonary artery embolism, left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [41.5% (34/82), 38.8% (14/36) vs. 16.2% (5/31), 10.0% (6/60)], with statistically significant differences (all P < 0.05). The incidences of pulmonary segmental artery embolism in the anterior/posterior tibial vein or peroneal vein thrombosis were higher than those in the mixed DVT and proximal DVT [41.9% (13/31) vs. 26.8% (22/82), 30.6% (11/36)], but the difference was not statistically significant (both P > 0.05). The incidences of pulmonary segmental artery embolism in the calf muscular venous thrombosis were significantly higher than those in the mixed DVT and the proximal DVT [66.7% (40/60) vs. 26.8% (22/82), 30.6% (11/36)], and the difference was statistically significant (both P < 0.05). The levels of D-dimer in patients with calf muscular venous thrombosis combined with main pulmonary artery embolism, left or right pulmonary artery trunk embolism were significantly higher than those in patients with calf muscular venous thrombosis combined pulmonary segmental artery embolism (mg/L: 6.08±3.12 vs. 3.66±2.66, P < 0.05). There were no significant differences in D-dimer levels in other patients with DVT combined with pulmonary embolism in different sites. In terms of the clinical manifestations of VTE, the incidences of lower limb swelling in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [54.9% (45/82), vs. 29.0% (9/31), 15.0% (9/60), both P < 0.05], the incidences of lower limb swelling in the proximal DVT were significantly higher than those in the calf muscular venous thrombosis [41.7% (15/63) vs. 15.0% (9/60), P < 0.05], there were no significant difference in the other clinical manifestations among the DVT groups. There was no significant difference in the incidence of VTE risk factors among the groups. The DVT of inpatients mostly occurred in the left lower limb, and the incidence of distal DVT was higher than that of proximal DVT. Mixed DVT and proximal DVT combined with pulmonary embolism mostly occurred in the main pulmonary artery, left or right pulmonary artery trunk, while distal DVT combined with pulmonary embolism mostly occurred in the pulmonary segmental artery. The levels of D-dimer in patients with lower extremity DVT combined with main pulmonary artery or left and right pulmonary artery trunk embolism were higher than those in patients with pulmonary lobe and segmental artery embolism. The incidence of lower extremity swelling in patients with mixed DVT and proximal DVT was higher than that in patients with distal DVT.

Protective Immunity of COVID-19 Vaccination with ChAdOx1 nCoV-19 Following Previous SARS-CoV-2 Infection: A Humoral and Cellular Investigation.

Infections caused by SARS-CoV-2 induce a severe acute respiratory syndrome called COVID-19 and have led to more than six million deaths worldwide. Vaccination is the most effective preventative measure, and cellular and humoral immunity is crucial to developing individual protection. Here, we aim to investigate hybrid immunity against SARS-CoV-2 triggered by the ChAadOx1 nCoV-19 vaccine in a Brazilian cohort. We investigated the immune response from ChAadOx1 nCoV-19 vaccination in naïve (noCOVID-19) and previously infected individuals (COVID-19) by analyzing levels of D-dimers, total IgG, neutralizing antibodies (Nabs), IFN-γ (interferon-γ) secretion, and immunophenotyping of memory lymphocytes. No significant differences in D-dimer levels were observed 7 or 15 days after vaccination (DAV). All vaccinated individuals presented higher levels of total IgG or Nabs with a positive correlation (R = 0.88). Individuals in the COVID-19 group showed higher levels of antibody and memory B cells, with a faster antibody response starting at 7 DAV compared to noCOVID-19 at 15 DAV. Further, ChAadOx1 nCoV-19 vaccination led to enhanced IFN-γ production (15 DAV) and an increase in activated T CD4+ naïve cells in noCOVID-19 individuals in contrast with COVID-19 individuals. Hence, our data support that hybrid immunity triggered by ChAadOx1 nCoV-19 vaccination is associated with enhanced humoral response, together with a balanced cellular response.

Safety and efficacy of colchicine in COVID-19 patients: A systematic review and meta-analysis of randomized control trials.

Colchicine has been used an effective anti-inflammatory drug to treat gout diseases. Owing to its pharmacodynamic of inhibiting interleukins, it has been repurposed to target the cytokine storm post-SARS-CoV-2 invasion. The goal of this meta-analysis was to evaluate the safety profile of colchicine in COVID-19 patients using the gold-standard randomised-control trials. Electronic databases (Pubmed, Google Scholar, and Cochrane) were systematically searched until June 2021 and RCTs were extracted. Outcomes of interest included all-cause mortality, COVID-19 severity, mechanical ventilation, C-reactive protein and D-dimer levels. Using a random-effects model, dichotomous outcomes were pooled using odds ratios (OR) through the generic inverse variance formula while weighted mean differences were calculated using the Wan's method. P-values < 0.05 were considered statistically significant for all outcomes. A total population of 16,048 from five RCTs were included in the analysis. Of this, 7957 were randomized to colchicine, and 8091 received standard care, with an average age of 60.67 years. Colchicine was observed to significantly reduce COVID-19 severity (OR: 0.41, 95% CI [0.22, 0.76]; p = 0.005), and CRP levels (WMD: -19.99, 95% CI [-32.09, -7.89]; p = 0.001). However, there was no significant difference in D-dimer levels (WMD: 0.31, 95% CI [-0.61, 1.23]; p = 0.51), mechanical ventilation (OR: 0.42, 95% CI [0.17, 1.03]; p = 0.06; I2 = 74%) and all-cause mortality (OR: 0.98, 95% CI [0.83, 1.16]; p = 0.84) among patients receiving colchicine or standard care. Colchicine treatment decreased CRP levels and COVID-19 severity, with dimer levels, all-cause mortality and mechanical ventilation remaining seemingly unaffected. Thus, clinical trials need to be carried out that allow effective evaluation of colchicine in COVID-19 patients.

Influence of sex on development of thrombosis in patients with COVID-19: From the CLOT-COVID study

IntroductionThere has been limited data on the influence of sex on development of thrombosis in patients with coronavirus disease 2019 (COVID-19). Materials and methodsThe CLOT-COVID Study was a retrospective, multicenter cohort study enrolling 2894 consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. We divided the entire cohort into the men (N = 1885) and women (N = 1009) groups. ResultsThere were no significant differences in D-dimer levels at admission between men and women. Men had more severe status of the COVID-19 at admission compared with women (Mild: 57% versus 66%, Moderate: 34% versus 29%, and Severe: 9.1% versus 5.7%, P < 0.001). Men more often received pharmacological thromboprophylaxis than women (47% versus 35%, P < 0.001). During the hospitalization, men more often developed thrombosis than women (2.5% [95%CI, 1.9–3.3%] versus 0.8% [95%CI, 0.4–1.6%], P = 0.001). Men had numerically higher incidences of thrombosis than women in all subgroups of the worst severity of COVID-19 during the hospitalization (Mild: 0.3% versus 0.0%, Moderate: 1.6% versus 1.0%, and Severe: 11.1% versus 4.3%). Even after adjusting confounders in the multivariable logistic regression model, the excess risk of men relative to women remained significant for thrombosis (adjusted OR, 2.51; 95%CI, 1.16–5.43, P = 0.02). ConclusionsIn the current large observational study of patients with COVID-19, men had more severe status of the COVID-19 than women, and the risk of development of thrombosis was higher in men compared with women, which could be helpful in determining the patient-specific optimal management strategies for COVID-19.

The Difference Of PT, aPTT, Fibrinogen, D-Dimer Activities In HIV Patients With CD4 Count Of &lt;200 uL And &gt;200 uL

ABSTRACT&#x0D; Introduction: HIV is a developing disease that has been a global problem. The progress of HIV infection is characterized by decreased CD4 count. Hemostasis disorder is often found in patients with HIV, where the formed virus-antibody complex can activate the coagulation system, beginning from the activation of the Hageman factor (Factor XII) into the active form (Factor XIIa). This factor will activate the fibrinolysis process. Fibrin polymer is broken down into fragments X and Y. Fragment Y is further broken down into Fragment D and E, which is known as D-dimer.&#x0D; Objective: To determine the difference of PT, aPTT, Fibrinogen, and D-Dimer in HIV patients with a CD4 lymphocyte count of &lt; 200/µL and &gt; 200/µL in H. Adam Malik General Hospital Medan.&#x0D; Hypothesis: There is a difference of PT and aPTT activities in HIV patients with a CD4 count of &lt; 200 cells/µL and ≥ 200 cells/µL and a difference of D-dimer and fibrinogen levels in HIV patients with a CD4 count of &lt; 200/µL and &gt; 200/µL in H. Adam Malik General Hospital Medan.&#x0D; Methods: This study was conducted in the Clinical Pathology Laboratory, Department of Internal Medicine, H. Adam Malik General Hospital. Samples were collected with a consecutive sampling method which included patients diagnosed with HIV in H. Adam Malik General Hospital Medan from September 2019 to July 2020 who fulfilled the inclusion and exclusion criteria. Thirty-eight patients were divided into two groups, i.e., HIV patients with a CD4 count of &lt; 200/µL and HIV patients with a CD4 lymphocyte count of &gt; 200/ µL.&#x0D; Results: Mann-Whitney test was used to assess the comparison of PT and aPTT values between HIV patients with a CD4 count of &lt; 200 cells/µL and ≥ 200 cells/µL. The result was significant with a p-value = 0.002, which means that there is a significant difference in PT and aPTT values between HIV patients with a CD4 count of &lt; 200 cells/µL and ≥ 200 cells/µL. An Independent T-test was used to assess the difference in fibrinogen level between HIV patients with a CD4 count of &lt; 200/µL and &gt; 200/µL, which resulted in p-value = 0.032. This means that there is a significant difference in fibrinogen levels between HIV patients with a CD4 count of &lt; 200/µL and &gt; 200/µL. Mann-Whitney test was used to determine the comparison in D-dimer level between HIV patients with a CD4 count of &lt; 200/µL and &gt; 200/µL, which showed a p-value = 0.002. This indicated a significant difference in D-dimer level between HIV patients with a CD4 count of &lt; 200/µL and &gt; 200/µL.&#x0D; Conclusion: The lower the CD4 lymphocyte count, the higher the activities of PT, aPTT, fibrinogen, and D-dimer in HIV patients.&#x0D; &#x0D; Keywords: HIV, PT, aPTT, D-Dimer, Fibrinogen, Hemostasis

Pulmonary embolisms in patients with COVID-19: A prevalence study in a tertiary hospital

IntroductionSARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. ObjectiveTo determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and d-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. MethodsThis retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. ResultsWe included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p = 0.0197; relative risk = 1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p = 0.43). There were no significant differences in d-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. ConclusionsPatients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of d-dimer levels does not differ between patients with COVID-19 and those without.

Management of Secondary Prevention in Venous Thromboembolism: Use of Reduced Doses of Rivaroxaban and Apixaban in Extended Therapy

BACKGROUND After a standard anticoagulation period (3-6 months), the risk of venous thromboembolism recurrence (RVTER) needs to be considered. Such risk is higher in unprovoked events and patients with persistent risk factor. The increase of D-dimer (DD) levels during the therapy seems to be strongly associated to RVTER. The use of rivaroxaban 10 mg/day and apixaban 2.5mg/12h as an extended therapy (ET) after the standard anticoagulation period has been proven to be an effective strategy to prevent recurrence without increasing bleeding events. AIM To assess the effectiveness and safety of reduced doses of rivaroxaban and apixaban as ET in patients with RVTER and to compare their DD levels with those of a control group on anticoagulant therapy at a standard dose. METHODS From April 2016 to June 2020, we included patients with venous thromboembolism (VTE) who received ET with rivaroxaban and apixaban with/at reduced doses. Dose reduction was performed following the clinical algorithm of our unit (Fig. 1). The DD values were determined using HemosIl D-Dimer HS-500 and the cut-off value was established at 500 µg/L DD levels were compared with a control group of 235 patients with VTE who received ET with standard doses of anticoagulation. DD levels were measured at the time of diagnosis (D1), initiation of treatment (D2) and 3 months after treatment (D3). RESULTS From a total of 116 patients (65.5% women), 77.6% (n=90) received rivaroxaban 10 mg/24h and 22.4% received apixaban 2.5 mg/12h as an ET. The mean duration of the initial anticoagulant therapy was 12 +/- 8.8 months. The mean DD value prior to the ET was 388 µg/L. In this group, 63.8% (n=74) was an unprovoked VTE and 17.2% (20) had hereditary thrombophilia. The mean of follow-up time was 6.9 +/- 8.3 months. No recurrences of VTE were observed during the follow-up and only one major bleeding event was reported in a high-bleeding risk patient. We observed a progressive decrease of DD levels from the VTE diagnosis to the last visit, with D1, D2, and D3 values of 987 µg/L ± 324, 388 µg/L ± 134, and 288 µg/L ± 98, respectively. There were no differences in d-dimer concentrations between patients with reduce doses of rivaroxaban or apixaban and the control group with standard doses (D1: 85.6% vs 81%, p =0.22; D2: 10.2% vs 8.0%, p =0.14; and D3: 9.1% vs 9.5%, p =0.18). CONCLUSIONS Our data indicated that an ET strategy with reduced doses of rivaroxaban or apixaban is effective and safe. We did not observe significant differences in DD levels at follow-up compared to the control group receiving a standard dose of anticoagulation. Further studies are needed in order to select and standardize dose reduction criteria in secondary prevention. Figure 1 Disclosures Campoy: boehringer ingelheim: Consultancy; Daiichi Sankyo: Speakers Bureau. Sierra:Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz Pharmaceuticals: Research Funding; Astellas: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead-Kite: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Daiichi Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Olivera:Daiichi Sankyo: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Boehringer Ingelheim: Consultancy, Speakers Bureau; BAYER: Consultancy.

Tromboembolismo pulmonar en pacientes con COVID-19: estudio de prevalencia en un hospital terciario

IntroductionSARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. ObjectiveTo determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. MethodsThis retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. ResultsWe included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p=0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p=0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. ConclusionsPatients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without.

Single-Drug Approach with Edoxaban is Effective for Resolving Non-Acute Cancer-Associated Venous Thrombosis: A Single-Arm Retrospective Analysis.

Recently, cancer-related venous thromboembolism (VTE) has been termed “cancer-associated thrombosis (CAT)” and is the focus of current research. We retrospectively investigated the efficacy of a single-drug approach with edoxaban for the treatment of non-acute CAT. Thirty-two non-acute CAT patients who received edoxaban were analyzed. The primary endpoint of this analysis was the thrombus disappearance rate at the first evaluation. Secondary endpoints included progression/recurrence of VTE, major bleeding, and D-dimer levels. The thrombus disappearance rate was 62.5%. Therefore, the null hypothesis for the primary endpoint (thrombus disappearance rate of ≤32.0%) was rejected (p = 0.00038) based on the rate of the previous study as the historical control. Recurrent VTE and major bleeding occurred in two patients each. After the start of treatment with edoxaban, a significant difference in D-dimer levels was observed (p = 0.00655). We demonstrated that a single-drug approach with edoxaban is a potential treatment option for non-acute CAT.

Application of D-dimer in diagnosis and prognosis of childhood Mycoplasma pneumoniae pneumonia

Objective To analyze the practical value of D-dimer in diseases condition judgment and prognosis evaluation of childhood Mycoplasma pneumoniae pneumonia (MPP). Methods Retrospective analysis was performed on clinical data of 606 MPP at Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from January 2009 to July 2017, and the subjects were divided a severe group (298 cases) and a moderate group (308 cases) according to severity.By comparing clinical characteristics, laboratory tests and imaging findings, multivariate Logistic regression analysis for significant single factors was accomplished, which was to find out the independent factors affecting the severity of childhood MPP in acute phase.Receiver operating characteristic (ROC) curves were drawn in the area under the curve (AUC) and the diagnosis threshold value was calculated, which could be used to judge the predicators affecting the severity judgment of childhood MPP in acute phase.And the prognosis was judged according to the convalescent fiberoptic bronchoscopic indicators in recovery phase. Results The levels of white blood cells (WBC)[(10.25±3.76)×109/L], neutrophil(Neu)[(7.31±3.76)×109/L], platelet (PLT)[(334.66±143.80)×109/L], C-reactive protein(CRP)[(69.00±80.50) mg/L], erythrocyte sedimentation (ESR)[(39.38±26.29) mm/1h], lactate dehydrogenase (LDH)[(436.61±248.96) IU/L], fibrinogen(Fib)[(4.61±1.36) g/L] and D-dimer [(2.09±1.66) mg/L]in the severe group were higher than those in the moderate group[(7.55±3.14)×109/L, (4.77±2.54)×109/L, (291.60±109.19)×109/L, (23.40±42.50) mg/L, (30.25±16.18) mm/1 h, (318.05±116.97) IU/L, (4.18±0.88) g, (0.58±0.72) mg/L], and the differences were statistically significant (all P<0.01). The levels of Neu, PLT, CRP, LDH and D-dimer were independent and relevant factors for the severity of acute MPP.The area under each ROC curve was Neu 0.719, PLT 0.592, LDH 0.675, CRP 0.749, D-dimer 0.848, and each diagnostic threshold was 6.5× 109/L, 265.5×109/L, 417.5 IU/L, 28.9 mg/L, 0.73 mg/L, respectively.Obviously, D-dimer had the highest sensitivity and specificity for the severe MPP.There was a significant difference in D-dimer level between the endobronchial inflammation group and the subbronchial stenosis, poor ventilation and occlusion group of fiberoptic bronchoscopy [(1.11±0.26) mg/L vs.(2.14±1.84) mg/L, t=-5.870, P<0.05]. Conclusion D-dimer levels can be used as one of the most sensitive indicator for determining the severity and prognosis of MPP. Key words: D-dimer; Child; Mycoplasma pneumoniae; Prognosis

The Association of D-dimer and Spontaneous Hemorrhagic Ascites with Outcomes in Cirrhosis: a Retrospective Study.

Cirrhotic patients with hemorrhagic ascites have significant morbidity and mortality. This study aims to determine the relationship between D-dimer values and hemorrhagic ascites in cirrhotic patients and analyze its predictive value. This retrospective study screened 572 consecutive cirrhotic patients with ascites and hemorrhagic ascites (defined as red blood cells (RBC) in ascitic fluid ≥ 10,000/µL) during a 72-month period. The overall patient survival rate was measured by Kaplan-Meier analysis method. The relationship between D-dimer and hemorrhagic ascites was also examined. A multivariate Cox proportional hazard analysis was performed to assess the indepen-dent risk factors related to mortality. Both control group and hemorrhagic ascites patients had obvious hepatic dysfunction as determined by Model for End-Stage Liver Disease (MELD) scores of 6.37 ± 1.05 and 11.82 ± 2.86, respectively (p < 0.001). There was a higher prevalence of patients with significant ascites in those with spontaneous hemorrhagic ascites than in the control group (p = 0.003). There were significant differences in D-dimer levels between both groups (9.44 ± 5.11 vs. 26.83 ± 5.35, p < 0.001). Hemorrhagic ascites was significantly and positively correlated with D-dimer levels (r = 0.692, p < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.9838. Using Cox proportional hazard model for multivariate prognostic analysis, MELD, D-dimer and presence of spontaneous hemorrhagic ascites were independent predictors of 3-year mortality. Patients with hemorrhagic ascites had a significantly higher MELD score, D-dimer, and mortality than patients with ascites alone. D-dimer was associated with the appearance of hemorrhagic ascites and was found to be a marker of advanced liver disease and poor outcomes.

D-dimer levels and cerebral infarction in critically ill cancer patients

BackgroundD-dimer levels have been used in the diagnosis of a variety of thrombosis-related diseases. In this study, we evaluated whether measuring D-dimer levels can help to diagnose cerebral infarction (CI) in critically ill cancer patients.MethodsWe retrospectively evaluated all cancer patients who underwent brain magnetic resonance imaging (MRI) between March 2010 and February 2014 at the medical oncology intensive care unit (ICU) of Samsung Medical Center. Brain MRI scanning was performed when CI was suspected due to acute neurological deficits. We compared D-dimer levels between patients ultimately diagnosed as having or not having CI and analyzed diffusion-weighted imaging (DWI) lesion patterns.ResultsA total of 88 patients underwent brain MRI scanning due to clinical suspicion of CI; altered mental status and unilateral hemiparesis were the most common neurological deficits. CI was ultimately diagnosed in 43 (49%) patients. According to the DWI patterns, multiple arterial infarctions (40%) were more common than single arterial infarctions (9%). Cryptogenic stroke etiologies were more common (63%) than determined etiologies. There was no significant difference in D-dimer levels between patients with and without CI (P = 0.319). Although D-dimer levels were not helpful in diagnosing CI, D-dimer levels were associated with cryptogenic etiologies in critically ill cancer patients; D-dimer levels were higher in the cryptogenic etiology group than in the determined etiology group or the non-infarction group (P = 0.001). In multivariate analysis, elevated D-dimer levels (> 8.89 μg/mL) were only associated with cryptogenic stroke (adjusted OR 5.46; 95% confidence interval, 1.876–15.857).ConclusionsAbnormal D-dimer levels may support the diagnosis of cryptogenic stroke in critically ill cancer patients.

The Role of Ischemia Modified Albumin and D-dimer as Early or Late Biochemical Markers in Ovarian Torsion.

Our aim was to examine the potential roles of ischemia modified albumin(IMA) and D-dimer as reliable early diagnostic markers of ovarian torsion. 24 Wistar albino rats were included and randomized into three groups. Control (sham) rats underwent laparotomy then bilateral ovaries removed for histopathological examination and concomitant blood sampling for IMA and D-dimer assays after 4 h. In the remaining groups, ovarian ischemia was achieved by rotating bilateral ovaries 1080° clockwise then blood samples were obtained and ovaries were removed after 4h and 24 h. IMA and D-dimer levels as well as the histopathological injury scores were assessed in all groups. A statistically higher significant difference in D-dimer levels in the 4-h torsion group (Group 2) than the other groups (P = 0.001, P < 0.01). Despite absence of statistical significance, the difference in IMA levels between the groups was close to statistical significance (P = 0.064; P > 0.05); accordingly IMA levels were higher in the 24-h torsion group (Group 3), than in 4-h torsion (Group 2) or sham (Group 1) group. Our results suggest that D-dimer may represent a valuable acute marker of ovarian torsion. The cut-off value for D-dimer was 402 ng/ml. Although rats in Group3 had higher IMA than in other groups, the difference was only close to statistical significance. Also, increasing duration of torsion was associated with reduced D-dimer levels, while IMA levels exhibited an increase during the 24 h period. In contrast with previous studies, IMA appeared to be a potential marker in the long term rather than the short term.

Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women.

To examine perinatal determinants of the antenatal levels of D-dimers. Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. D-dimer levels in group 4 (38-40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past (P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women (P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset (P = 0.003) and induction of labour (P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery (P = 0.008) and instrumental vaginal delivery (P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section (P = 0.008). There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.