A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study

Abstract

Purpose COVID-19 raises D-dimer (DD) levels even in the absence of pulmonary embolism (PE), resulting in an increase in computed tomography pulmonary angiogram (CTPA) requests. Our purpose is to determine whether there are differences between DD values in PE-positive and PE-negative COVID-19 patients and, if so, to establish a new cutoff value which accurately determines when a CTPA is needed. Methods This study retrospectively analyzed all COVID-19 patients who underwent a CTPA due to suspected PE between March 1

Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis

“…However, there is no uniformly accepted D-dimer threshold to discriminate COVID-19 patients with and without PE. Twelve studies used different D-dimer cutoff levels (varying between 1000 and 4800 μg/L), yielding sensitivity and specificity values which varied between 63–100% and 23–84%, respectively [ 11 , 24 , 33 , 52 , 58 , 60 , 71 , 74 , 78 , 82 , 86 , 89 ]. These D-dimer cutoff levels were at least twice as high compared to the conventional D-dimer cutoff level of 500 μg/L, which is usually employed in the general population as a screening test for venous thromboembolism [ 104 , 105 ].…”

Venous thromboembolism in COVID-19: A systematic review and meta-analysis

“…Ventura-Díaz et al 20 Espallargas et al 25 Mueller-Peltzer et al 26 Ramadan et al 27 Mouhat et al 30 Alonso-Fernández et al 32 Monfardini et al 39 Freund et al 40 Chen et al 41 Whyte et al 43 Fauvel et al 45 Larsen et al 48 Bavaro et al 51 Mazzaccaro et al 53 Gervaise et al 54 Poyiadji et al 60 Bompard et al 62 BDL Overall (I 2 = 94.8%) patients with severe COVID-19. 68 It has been suggested that SARS-Cov-2 in severe forms of the disease induces an excessive inflammatory state via cytokine storm combined with endothelial injury and pulmonary vascular microthrombosis, which could considerably increase the risk for VTE, mainly PE.…”

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

“…This led to modify the indications for chest CT in COVID-19 patients, primarily limited to non-contrast examinations for the evaluation of parenchymal abnormalities or assessment of alternative diagnoses. CT angiography was then considered in the management of patients exhibiting acute or subacute respiratory distress, enabling depiction of endoluminal filling defects in up to 30% of patients, mainly located within segmental and subsegmental arteries [7] , [8] , [9] , [10] , [11] , [12] . Although endoluminal clots could result from a thromboembolic disease, autopsy studies highlighted changes consistent with thrombosis occurring within the pulmonary arterial circulation in the absence of apparent embolism [5] .…”

“…Although endoluminal clots could result from a thromboembolic disease, autopsy studies highlighted changes consistent with thrombosis occurring within the pulmonary arterial circulation in the absence of apparent embolism [5] . This was also clinically suggested by the low proportion of patients with PE in whom deep vein thrombosis was diagnosed [ 8 , 9 ].…”