D-dimer for the diagnosis of acute venous thromboembolism in the emergency department: a Janus-face marker

Manfredini, Roberto

doi:10.1007/bf02934723

Cited by 6 publications

(4 citation statements)

References 52 publications

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“…As shown in Tables 1 and 2 , high D-Dimer levels have been measured in all patients, despite the result of CUS. Therefore, in this setting, on one hand D-Dimer showed a poor usefulness in relation to its high negative predictive value; whereas, on the other, its correlation between elevated D-Dimer levels and VTE should be better investigated and specific cut-off defined [ 35 , 40 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

Giorgi‐Pierfranceschi

Paoletti

Pan

et al. 2020

Intern Emerg Med

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The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.

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Section: Discussionmentioning

confidence: 99%

Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

Giorgi‐Pierfranceschi

Paoletti

Pan

et al. 2020

Intern Emerg Med

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“…Although highly elevated levels of D-dimer in COVID-19 have been attributed to acute lung injury with intraalveolar fibrin deposition and subsequent breakdown of this extravascular fibrin, D-dimer values may be elevated for a variety of reasons and therefore increased values are not only indicative of increased thrombotic risk. [7][8][9][10] For this reason, there is a need to identify new biomarkers that provide a rapid and effective assessment of thrombotic risk in COVID- 19.…”

Section: Introductionmentioning

confidence: 99%

Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients

López-Jaime

Bello

Martin-Tellez

et al. 2022

Clin Appl Thromb Hemost

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A high risk of thrombotic complications has been observed among severely ill COVID-19 patients. Viscoelastic tests (VET) have shown a hypercoagulable profile in these patients, although so far there is no clear evidence on the use of these tools as predictors of risk in the clinical course of patients. In this study we aimed to evaluate the association between Quantra® sonorheometry VET parameters, standard coagulation tests and inflammatory markers in 69 patients with COVID-19 on hospital admission with disease severity and outcome. Inflammatory markers were elevated in a high percentage of patients, as were coagulation-related parameters such as fibrinogen and D-dimer levels. Quantra® sonorheometry analysis revealed increased clot stiffness (CS), especially due to increased fibrinogen contribution (FCS) in 63.7%. Analysis of clot stability to lysis (CSL) on the Quantra showed a value of 100%, suggesting hypofibrinolysis, in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased CS and CSL were significantly associated with worsening disease. The combination of elevated FCS and D-dimer values showed a particularly high prognostic value in distinguishing patients with severe symptomatology. In conclusion, FCS measured by Quantra® system and its combination with D-dimer could be established as a powerful tool to identify poor prognosis in COVID-19 patients on hospital admission.

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“…D-dimer in particular has important limitations that raises questions on its true prognostic value for thrombosis in COVID-19. Although highly elevated levels of D-dimer in COVID-19 have been attributed to acute lung injury with intra-alveolar fibrin deposition and subsequent breakdown of this extravascular fibrin, D-dimer values may be elevated for a variety of reasons and therefore increased values are not only indicative of increased thrombotic risk [7][8][9][10]. In addition, D-dimer requires a long time of analysis which together weaken its clinical value and reveals the need to identify new biomarkers that provide a rapid and effective assessment of thrombotic risk in COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Clot Stiffness Measured by Seer Sonorheometry as a Marker of Poor Prognosis in Hospitalized Covid-19 Patients

López-Jaime

Martin-Tellez

Doblas-Marquez

et al. 2021

Preprint

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Background: High incidence of life-threatening thrombotic complications is observed in severely ill COVID-19 patients. D-dimer may help evaluate disease severity and predict outcomes at hospital admission. However, its non-specificity and long analysis times strongly constrain its clinical value. Viscoelastic tests (VET) are widely available rapid point-of-care devices that have been shown to detect a hypercoagulable state (increased clot stiffness and fibrinolysis shutdown) as major contributors of the thrombotic complication in COVID-19. Nevertheless, based on the data obtained so far, definitive conclusions have not been drawn. Objectives: We aim to evaluate the association between VET parameters, standard coagulation tests and inflammation markers assessed in COVID-19 patients at hospital admission with disease severity and outcomes. Patients/Methods: A total of 69 COVID-19 patients requiring hospitalization were included in the study. The pro-inflammatory and pro-thrombotic state was analyzed by a panel of inflammation markers (IL-6, CRP, LDH, ferritin), routine coagulation tests (PT, aPTT, platelet count, fibrinogen, D-dimer) and a SEER sonorheometry VET profile (Quantra System). Results: Inflammatory markers IL-6, CRP, LDH and ferritin were elevated in a high percentage of patients (73.6%, 89.2%, 57.1% and 52.4%), as were coagulation-related parameters such as fibrinogen (81.4%) and D-dimer levels (66.2%). Quantra analysis revealed increased clot stiffness (CS) in 34.8%, particularly due to increased fibrinogen contribution (FCS) in 63.7%. Increased clot stability to lysis (CSL) was observed in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased clot stiffness and resistance to clot lysis were significantly associated with worsening disease. The Quantra FCS parameter showed a particularly high prognostic value in distinguishing patients with severe symptomatology. Conclusion: The global study of hemostasis by the whole blood point-of-care Quantra VET system may be a powerful tool for identifying poor prognosis in COVID-19 patients at hospital admission. In particular, FCS measured by Quantra could be established as a plausible prognostic marker to aid the clinical management of COVID-19 patients.

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D-dimer for the diagnosis of acute venous thromboembolism in the emergency department: a Janus-face marker

Cited by 6 publications

References 52 publications

Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients

Clot Stiffness Measured by Seer Sonorheometry as a Marker of Poor Prognosis in Hospitalized Covid-19 Patients

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