Don't let D-dimer fool you: Elevated D-dimer plasma levels should not imply ‘hyperfibrinolysis’

Hardy, Michaël; Bareille, Marion; Lecompte, T.; Mullier, François

doi:10.1016/j.thromres.2022.04.012

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…By contrast, this phase associates a systemic activation of the coagulation cascadewith “fibrinolysis shutdown”—similarly to SIC—as found by viscoelastic testing, despite the overwhelming increase in serum D-dimers [ 234 , 251 , 255 , 256 , 258 ]. In fact, several authors have recently pointed out that D-dimer levels are only associated with fibrin formation dynamics, and high D-dimers do not necessarily imply systemic hyperfibrinolysis; therefore, in COVID-19, evidence points towards an extravascular—i.e., pulmonary—source of D-dimers [ 259 ].…”

Section: From Theory To Practice—clinical Aspects Of Coagulopathy In ...mentioning

confidence: 99%

Coagulation Disorders in Sepsis and COVID-19—Two Sides of the Same Coin? A Review of Inflammation–Coagulation Crosstalk in Bacterial Sepsis and COVID-19

Tuculeanu

Barbu

Lazăr

et al. 2023

JCM

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Sepsis is a major cause of morbidity and mortality worldwide. Sepsis-associated coagulation disorders are involved in the pathogenesis of multiorgan failure and lead to a subsequently worsening prognosis. Alongside the global impact of the COVID-19 pandemic, a great number of research papers have focused on SARS-CoV-2 pathogenesis and treatment. Significant progress has been made in this regard and coagulation disturbances were once again found to underlie some of the most serious adverse outcomes of SARS-CoV-2 infection, such as acute lung injury and multiorgan dysfunction. In the attempt of untangling the mechanisms behind COVID-19-associated coagulopathy (CAC), a series of similarities with sepsis-induced coagulopathy (SIC) became apparent. Whether they are, in fact, the same disease has not been established yet. The clinical picture of CAC shows the unique feature of an initial phase of intravascular coagulation confined to the respiratory system. Only later on, patients can develop a clinically significant form of systemic coagulopathy, possibly with a consumptive pattern, but, unlike SIC, it is not a key feature. Deepening our understanding of CAC pathogenesis has to remain a major goal for the research community, in order to design and validate accurate definitions and classification criteria.

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Section: From Theory To Practice—clinical Aspects Of Coagulopathy In ...mentioning

confidence: 99%

Coagulation Disorders in Sepsis and COVID-19—Two Sides of the Same Coin? A Review of Inflammation–Coagulation Crosstalk in Bacterial Sepsis and COVID-19

Tuculeanu

Barbu

Lazăr

et al. 2023

JCM

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“…In our study there was no significant association between D-dimer values and ATE/ VTE, mortality or ARDS severity. Of note, the origin of D-dimers is complex and elevated D-dimers do not necessarily indicate enhanced fibrinolysis because large extravascular deposits of fibrin may also increase D-dimer levels [69]. Especially in COVID-19 ARDS the lung might be the most important source of D-dimers [28], for instance due to fibrin deposits within pulmonary alveoli.…”

Section: Predictive Ability Of Vet Compared To Conventional Laborator...mentioning

confidence: 99%

Predictive ability of viscoelastic testing using ClotPro® for short-term outcome in patients with severe Covid-19 ARDS with or without ECMO therapy: a retrospective study

et al. 2022

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Background SARS-CoV-2 infections are suspected to trigger the coagulation system through various pathways leading to a high incidence of thromboembolic complications, hypercoagulation and impaired fibrinolytic capacity were previously identified as potentially mechanisms. A reliable diagnostic tool for detecting both is still under discussion. This retrospective study is aimed to examine the prognostic relevance of early viscoelastic testing compared to conventional laboratory tests in COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods All mechanically ventilated patients with COVID-19 related ARDS treated in our intensive care unit (ICU) between January and March 2021 were included in this study. Viscoelastic testing (VET) was performed using the ClotPro® system after admission to our ICU. Prevalence of thromboembolic events was observed by standardized screening for venous and pulmonary thromboembolism using complete compression ultrasound and thoracic computed tomography pulmonary angiography at ICU admission, respectively. We examined associations between the severity of ARDS at admission to our ICU, in-hospital mortality and the incidence of thromboembolic events comparing conventional laboratory analysis and VET. ECMO related coagulopathy was investigated in a subgroup analysis. The data were analyzed using the Mann–Whitney U test. Results Of 55 patients enrolled in this study, 22 patients required treatment with ECMO. Thromboembolic complications occurred in 51% of all patients. Overall hospital mortality was 55%. In patients with thromboembolic complications, signs of reduced fibrinolytic capacity could be detected in the TPA assay with prolonged lysis time, median 460 s (IQR 350–560) vs 359 s (IQR 287–521, p = 0.073). Patients with moderate to severe ARDS at admission to our ICU showed increased maximum clot firmness as a sign of hypercoagulation in the EX-test (70 vs 67 mm, p < 0.05), FIB-test (35 vs 24 mm, p < 0.05) and TPA-test (52 vs 36 mm, p < 0.05) as well as higher values of inflammatory markers (CRP, PCT and IL6). ECMO patients suffered more frequently from bleeding complications (32% vs 15%). Conclusion Although, the predictive value for thromboembolic complications or mortality seems limited, point-of-care viscoelastic coagulation testing might be useful in detecting hypercoagulable states and impaired fibrinolysis in critically ill COVID-19 ARDS patients and could be helpful in identifying patients with a potentially very severe course of the disease.

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D-dimer testing: A narrative review

Wauthier

Favresse

Hardy³

et al. 2023

Advances in Clinical Chemistry

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Don't let D-dimer fool you: Elevated D-dimer plasma levels should not imply ‘hyperfibrinolysis’

Cited by 3 publications

References 16 publications

Coagulation Disorders in Sepsis and COVID-19—Two Sides of the Same Coin? A Review of Inflammation–Coagulation Crosstalk in Bacterial Sepsis and COVID-19

Coagulation Disorders in Sepsis and COVID-19—Two Sides of the Same Coin? A Review of Inflammation–Coagulation Crosstalk in Bacterial Sepsis and COVID-19

Predictive ability of viscoelastic testing using ClotPro® for short-term outcome in patients with severe Covid-19 ARDS with or without ECMO therapy: a retrospective study

D-dimer testing: A narrative review

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