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D-dimer levels in VTE patients with distal and proximal clots.

Publication ,  Journal Article
Singer, AJ; Zheng, H; Francis, S; Fermann, GJ; Chang, AM; Parry, BA; Giordano, N; Kabrhel, C
Published in: Am J Emerg Med
January 2019

OBJECTIVES: There is growing evidence that venous thromboembolism (VTE) patients with distal clots (distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE]) may not routinely benefit from anticoagulation. We compared the D-dimer levels in VTE patients with distal and proximal clots. METHODS: We conducted a multinational, prospective observational study of low-to-intermediate risk adult patients presenting to the emergency department (ED) with suspected VTE. Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate analyses. RESULTS: Of 1752 patients with suspected DVT, 1561 (89.1%) had no DVT, 78 (4.4%) had a distal calf DVT, and 113 (6.4%) had a proximal DVT. DVT patients with proximal clots had higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL were 40.7% and 52.1% respectively. Of 1834 patients with suspected PE, 1726 (94.1%) had no PE, 7 (0.4%) had isolated sub-segmental PE, and 101 (5.5%) had non-sub-segmental PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL) than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer cutoff of 3499 mg/dL were 57.4% and 10.4% respectively. CONCLUSIONS: VTE patients with proximal clots had higher D-dimer levels than patients with distal clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients with distal or proximal clots.

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Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

January 2019

Volume

37

Issue

1

Start / End Page

33 / 37

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Sensitivity and Specificity
  • Pulmonary Embolism
  • Prospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Hemagglutination Tests
  • Fibrin Fibrinogen Degradation Products
 

Citation

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Singer, A. J., Zheng, H., Francis, S., Fermann, G. J., Chang, A. M., Parry, B. A., … Kabrhel, C. (2019). D-dimer levels in VTE patients with distal and proximal clots. Am J Emerg Med, 37(1), 33–37. https://doi.org/10.1016/j.ajem.2018.04.040
Singer, Adam J., Hui Zheng, Samuel Francis, Gregory J. Fermann, Anne Marie Chang, Blair A. Parry, Nick Giordano, and Christopher Kabrhel. “D-dimer levels in VTE patients with distal and proximal clots.Am J Emerg Med 37, no. 1 (January 2019): 33–37. https://doi.org/10.1016/j.ajem.2018.04.040.
Singer AJ, Zheng H, Francis S, Fermann GJ, Chang AM, Parry BA, et al. D-dimer levels in VTE patients with distal and proximal clots. Am J Emerg Med. 2019 Jan;37(1):33–7.
Singer, Adam J., et al. “D-dimer levels in VTE patients with distal and proximal clots.Am J Emerg Med, vol. 37, no. 1, Jan. 2019, pp. 33–37. Pubmed, doi:10.1016/j.ajem.2018.04.040.
Singer AJ, Zheng H, Francis S, Fermann GJ, Chang AM, Parry BA, Giordano N, Kabrhel C. D-dimer levels in VTE patients with distal and proximal clots. Am J Emerg Med. 2019 Jan;37(1):33–37.
Journal cover image

Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

January 2019

Volume

37

Issue

1

Start / End Page

33 / 37

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Sensitivity and Specificity
  • Pulmonary Embolism
  • Prospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Hemagglutination Tests
  • Fibrin Fibrinogen Degradation Products