D-dimer prognostic role in thromboembolism occurrence: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
| Line 7: | Line 7: | ||
==Occurrence of VTE== | ==Occurrence of VTE== | ||
* The predictive value of D-dimer for the occurrence of [[VTE]] has been investigated among 923 subjects from the LITE study which data is a combination of data from the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). [[VTE]] was defined as [[DVT]] confirmed by positive venogram, duplex, or Doppler ultrasound or [[PE]] confirmed by [[pulmonary angiography]]. One measurement of D-dimer was obtained from stored blood samples and data about the subjects were obtained from hospital medical records. Elevated levels of D-dimers have been shown to be associated with an increased incidence of [[VTE]] in general whether idiopathic or secondary to a non-[[cancer]] cause independently of the presence of the commonly inherited coagulopathies. According to this study, elevated levels of D-dimers were not associated with higher risk of cancer-related [[VTE]]; nevertheless, this finding might have been influenced by the fact that at the time of withdrawal of blood the subjects did not have cancer.<ref name="pmid12393393">{{cite journal| author=Cushman M, Folsom AR, Wang L, Aleksic N, Rosamond WD, Tracy RP et al.| title=Fibrin fragment D-dimer and the risk of future venous thrombosis. | journal=Blood | year= 2003 | volume= 101 | issue= 4 | pages= 1243-8 | pmid=12393393 | doi=10.1182/blood-2002-05-1416 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12393393 }} </ref> | * The predictive value of D-dimer for the occurrence of [[VTE]] has been investigated among 923 subjects from the LITE study which data is a combination of data from the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). [[VTE]] was defined as [[DVT]] confirmed by positive venogram, duplex, or Doppler ultrasound or [[PE]] confirmed by [[pulmonary angiography]]. One measurement of D-dimer was obtained from stored blood samples and data about the subjects were obtained from hospital medical records. Elevated levels of D-dimers have been shown to be associated with an increased incidence of [[VTE]] in general whether idiopathic or secondary to a non-[[cancer]] cause independently of the presence of the commonly inherited coagulopathies. According to this study, elevated levels of D-dimers were not associated with higher risk of cancer-related [[VTE]]; nevertheless, this finding might have been influenced by the fact that at the time of withdrawal of blood the subjects did not have cancer.<ref name="pmid12393393">{{cite journal| author=Cushman M, Folsom AR, Wang L, Aleksic N, Rosamond WD, Tracy RP et al.| title=Fibrin fragment D-dimer and the risk of future venous thrombosis. | journal=Blood | year= 2003 | volume= 101 | issue= 4 | pages= 1243-8 | pmid=12393393 | doi=10.1182/blood-2002-05-1416 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12393393 }} </ref> Following the publication of this article, this study has received criticism regarding several points. First of all, the prediction of the thrombotic risk based on the D-dimer level relied on the analysis of data that included only one measurement of the D-dimer level without taking into consideration the fluctuation that can occur in D-dimer levels across time. In addition, the cut off points for normal and abnormal D-dimer in the case of subjects with thrombophilia were the same as subjects without thrombophilia. And lastly, the critics addressed a concern regarding highly elevated levels of D-dimer in healthy individuals which raises the question that high D-dimer levels might be resulting from either high production or decreased clearance of D-dimers; therefore, it might be beneficial if future larger studies measure plasma/urine D-dimer ratio rather than plasma D-dimer alone. This is particularly important in order to differentiate healthy individuals from subjects with asymptomatic [[VTE]].<ref name="pmid14656870">{{cite journal| author=Sivakumaran M, Malton N| title=Plasma D-dimer measurement as a predictor of venous thrombosis. | journal=Blood | year= 2003 | volume= 102 | issue= 13 | pages= 4618; author reply 4618-9 | pmid=14656870 | doi=10.1182/blood-2003-09-2998 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14656870 }} </ref> | ||
* A study was conducted in China on 458 patients whose mean age is 77 years and who were hospitalized for at least 3 days for either heart failure, respiratory failure, ischemic stroke, infection or recent surgery in order to evaluate whether elevated D-dimer levels more than 500 ng/ml is associated with high risk of occurrence of [[VTE]] in elderly patients hospitalized for acute illness. [[VTE]] events were defined as either asymptomatic [[DVT]] diagnosed by compression [[ultrasound]] at the enrollment day and three weeks afterwards or symptomatic [[VTE]] within 90 days of the enrollement. The results of this study were adjusted for gender, age, [[BMI]], the acute medical disease and pre-existing comorbidities and they can be summarized as follow: | * A study was conducted in China on 458 patients whose mean age is 77 years and who were hospitalized for at least 3 days for either heart failure, respiratory failure, ischemic stroke, infection or recent surgery in order to evaluate whether elevated D-dimer levels more than 500 ng/ml is associated with high risk of occurrence of [[VTE]] in elderly patients hospitalized for acute illness. [[VTE]] events were defined as either asymptomatic [[DVT]] diagnosed by compression [[ultrasound]] at the enrollment day and three weeks afterwards or symptomatic [[VTE]] within 90 days of the enrollement. The results of this study were adjusted for gender, age, [[BMI]], the acute medical disease and pre-existing comorbidities and they can be summarized as follow: | ||
Revision as of 20:54, 26 September 2013
|
D-Dimer Microchapters |
|
Clinical Correlation |
|---|
|
Clinical Trials |
|
D-dimer prognostic role in thromboembolism occurrence On the Web |
|
American Roentgen Ray Society Images of D-dimer prognostic role in thromboembolism occurrence |
|
FDA on D-dimer prognostic role in thromboembolism occurrence |
|
CDC on D-dimer prognostic role in thromboembolism occurrence |
|
D-dimer prognostic role in thromboembolism occurrence in the news |
|
Blogs on D-dimer prognostic role in thromboembolism occurrence |
|
Risk calculators and risk factors for D-dimer prognostic role in thromboembolism occurrence |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The association between D-dimer levels and occurrence of VTE is not a causal relationship, but D-dimer level is rather a marker of hemostatic abnormalities that predict higher risk of thromboembolism.
Occurrence of VTE
- The predictive value of D-dimer for the occurrence of VTE has been investigated among 923 subjects from the LITE study which data is a combination of data from the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). VTE was defined as DVT confirmed by positive venogram, duplex, or Doppler ultrasound or PE confirmed by pulmonary angiography. One measurement of D-dimer was obtained from stored blood samples and data about the subjects were obtained from hospital medical records. Elevated levels of D-dimers have been shown to be associated with an increased incidence of VTE in general whether idiopathic or secondary to a non-cancer cause independently of the presence of the commonly inherited coagulopathies. According to this study, elevated levels of D-dimers were not associated with higher risk of cancer-related VTE; nevertheless, this finding might have been influenced by the fact that at the time of withdrawal of blood the subjects did not have cancer.[1] Following the publication of this article, this study has received criticism regarding several points. First of all, the prediction of the thrombotic risk based on the D-dimer level relied on the analysis of data that included only one measurement of the D-dimer level without taking into consideration the fluctuation that can occur in D-dimer levels across time. In addition, the cut off points for normal and abnormal D-dimer in the case of subjects with thrombophilia were the same as subjects without thrombophilia. And lastly, the critics addressed a concern regarding highly elevated levels of D-dimer in healthy individuals which raises the question that high D-dimer levels might be resulting from either high production or decreased clearance of D-dimers; therefore, it might be beneficial if future larger studies measure plasma/urine D-dimer ratio rather than plasma D-dimer alone. This is particularly important in order to differentiate healthy individuals from subjects with asymptomatic VTE.[2]
- A study was conducted in China on 458 patients whose mean age is 77 years and who were hospitalized for at least 3 days for either heart failure, respiratory failure, ischemic stroke, infection or recent surgery in order to evaluate whether elevated D-dimer levels more than 500 ng/ml is associated with high risk of occurrence of VTE in elderly patients hospitalized for acute illness. VTE events were defined as either asymptomatic DVT diagnosed by compression ultrasound at the enrollment day and three weeks afterwards or symptomatic VTE within 90 days of the enrollement. The results of this study were adjusted for gender, age, BMI, the acute medical disease and pre-existing comorbidities and they can be summarized as follow:
References
- ↑ Cushman M, Folsom AR, Wang L, Aleksic N, Rosamond WD, Tracy RP; et al. (2003). "Fibrin fragment D-dimer and the risk of future venous thrombosis". Blood. 101 (4): 1243–8. doi:10.1182/blood-2002-05-1416. PMID 12393393.
- ↑ Sivakumaran M, Malton N (2003). "Plasma D-dimer measurement as a predictor of venous thrombosis". Blood. 102 (13): 4618, author reply 4618-9. doi:10.1182/blood-2003-09-2998. PMID 14656870.
- ↑ Fan J, Li X, Cheng Y, Yao C, Zhong N, Investigators Group (2011). "Measurement of D-dimer as aid in risk evaluation of VTE in elderly patients hospitalized for acute illness: a prospective, multicenter study in China". Clin Invest Med. 34 (2): E96–104. PMID 21463550.