D-Dimer to Predict the Clinical Outcomes in Patients with Mechanical Heart Valve Replacement During Oral Anticoagulation Therapy

Abstract

Mechanical heart valve replacement (MHVR) entails lifetime oral anticoagulation to eliminate thrombosis. However, adverse events may still occur despite proper anticoagulation therapy. In this study, we investigated whether D-dimer can predict the clinical events in post-MHVR patients during oral anticoagulation therapy. This was a single-center, prospective study. In all, 772 patients who underwent MHVR in the Wuhan Asia Heart Hospital from January 2013 to May 2014 were screened. Patients were assigned to the abnormal D-dimer group and the normal D-dimer group according to the D-dimer levels measured 3 months after the beginning of the oral anticoagulation therapy regime. All patients were followed up for 24 months or until the observation of the endpoints, which included thrombotic events, bleeding events, and all-cause deaths. A total of 718 patients were included in the analysis: 91 had abnormal D-dimer levels, and 627 had normal D-dimer levels. In all, 53 events were observed during 24 months. Compared with the normal D-dimer group, patients with abnormal D-dimer levels had a higher incidence of thrombotic events (10 versus 14; hazard

Diagnostic management of inpatients with a positive D‐dimer test: developing a new clinical decision‐making rule for pulmonary embolism

“…In cases of missed PE diagnosis, some clinicians manage these patients radically by broadly assigning examinations, such as CTPA, VA scans, chest 64-detector row CT, or even anticoagulation therapy, as preventive measures. 33 In contrast, some clinicians choose to temporarily wait when inpatients have a positive D-dimer result and reexamine their plasma D-dimer levels after a few days. However, the patient's symptoms could become aggravated during this time, resulting in further necessary measures.…”

Use of D‐dimer in oral anticoagulation therapy

“…Third, D‐dimer predicts the clinical outcomes of patients with mechanical heart valve replacement (MHVR). Two prospective studies with 2 years of follow‐up and involving 132 and 618 subjects showed that the risk of clinical events in post‐MHVR patients with abnormal D‐dimer levels is approximately fivefold higher than those with normal D‐dimer levels . Multivariate regression analysis exhibited that D‐dimer level is an independent predictor of thrombotic events during anticoagulation therapy.…”

“…Two prospective studies with 2 years of follow-up and involving 132 and 618 subjects showed that the risk of clinical events in post-MHVR patients with abnormal D-dimer levels is approximately fivefold higher than those with normal D-dimer levels. 33,34 Multivariate regression analysis exhibited that D-dimer level is an independent predictor of thrombotic events during anticoagulation therapy. Moreover, among patients with heart failure, cancer, and other conditions requiring anticoagulation therapy, the abnormal level of D-dimer is significantly associated with subsequent deaths, cancer-related VTE, and other adverse outcomes.…”

Risk factors for hypercoagulability after laparoscopic hepatic haemangioma resection

“…D-Di is a specific degradation product of fibrin monomer cross-linked by activated factor XIII and then hydrolysed by fibrinolytic enzymes, which is a valuable indicator of blood hypercoagulation and thrombotic diseases. [ 37 , 38 ] It is one of the markers that respond to a hypercoagulable state and secondary hyperfibrinolysis in vivo , as its elevation reflects enhanced secondary fibrinolytic activity and excessive thrombin production. [ 39 , 40 ] Myocardial infarction, venous thrombosis or PE, diffuse intravascular coagulation can all lead to increased D-Di.…”