High D‐dimer level is associated with increased 15‐d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity

Klok, Frederikus A.; Djurabi, R. Karami; Nijkeuter, Mathilde; Eikenboom, Jeroen; Leebeek, Frank W.G.; Kramer, Mark H. H.; Kaasjager, Karin; Kamphuisen, Pieter Willem; Büller, Harry R.; Huisman, M. V.

doi:10.1111/j.1365-2141.2007.06888.x

Cited by 61 publications

(62 citation statements)

References 15 publications

(19 reference statements)

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“…The only study also showing a correlation between high Ddimer levels and 15-day mortality was performed in 262 patients with less likely clinical probability of PE (Wells score < 4 points), and who were derived from a diagnostic management study that excluded patients with a life expectancy < 3 months, were pregnant or who were hemodynamically unstable [22]. Our findings may be applicable for all patients with acute PE.…”

Section: Discussionmentioning

confidence: 77%

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D‐dimer levels and 15‐day outcome in acute pulmonary embolism. Findings from the RIETE Registry

Lobo

Zorrilla

Aizpuru

et al. 2009

Journal of Thrombosis and Haemostasis

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Summary. Background: A number of variables have been evaluated for risk stratification in patients with acute pulmonary embolism (PE). Whereas increased D‐dimer levels have been associated with mortality at 3 months, its role in predicting short‐term outcome (the period of time during which any therapeutic decision has to be taken) remains unclear. Methods: RIETE is an ongoing, prospective registry of consecutive patients with acute venous thromboembolism. We assessed the prognostic value of D‐dimer levels at baseline, measured with an automated latex agglutination test (IL Test D‐dimer®), on the 15‐day outcome in patients with acute PE. Overall mortality, fatal PE and major bleeding rates were compared by quartile. Results: As of February 2008, 1707 patients with acute PE underwent D‐dimer testing. Of these, 72 patients (4.2%) died during the first 15 days, 11 (0.6%) had recurrent PE, and 29 (1.7%) had major bleeding. Overall mortality increased with increasing D‐dimer levels, from 2.7% in the first quartile (< 1050 ng mL−1) to 7.0% in the fourth quartile (≥ 4200 ng mL−1). The rates of fatal PE and major bleeding also increased. On multivariate analysis, patients with D‐dimer levels in the fourth quartile had an increased risk for overall death (odds ratio, 1.8; 95% CI, 1.1–3.2), fatal PE (odds ratio, 2.0; 95% CI, 1.0–3.8) or major bleeding (odds ratio, 3.2; 95% CI, 1.5–7.0). Conclusions: PE patients with D‐dimer levels in the fourth quartile had an increased incidence of overall death, fatal PE and major bleeding within 15 days both before and after multivariate adjustment.

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Section: Discussionmentioning

confidence: 77%

“…Increased D-dimer levels at baseline in patients with PE have been associated with thrombus extension and increased mortality at 3 months [20][21][22][23][24][25][26], but its ability to predict short-term outcome remains unclear.…”

Section: Introductionmentioning

confidence: 99%

D‐dimer levels and 15‐day outcome in acute pulmonary embolism. Findings from the RIETE Registry

Lobo

Zorrilla

Aizpuru

et al. 2009

Journal of Thrombosis and Haemostasis

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“…Furthermore, warfarin treatment reduces stroke severity and subsequent risk of death [11,12,13,14,15], as well as the level of D -dimer in NVAF patients [16]. Although D -dimer level is associated with the clinical outcome of pulmonary embolism [17,18,19], the relationship between D -dimer level and cerebral embolism severity in NVAF patients remains unclear. Assessing the D -dimer level would facilitate stroke prevention, especially severe cerebral infarction in NVAF patients.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Matsumoto

Sakaguchi²,

Okazaki³

et al. 2013

Cerebrovasc Dis

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Background: Plasma D-dimer level may reflect the activity of thrombus formation in the left atrium of patients with nonvalvular atrial fibrillation (NVAF). Proper anticoagulation with warfarin dramatically decreases the rate of cerebral embolism, reduces stroke severity and subsequent risk of death, as well as the level of D-dimer in NVAF patients. However, the predictive value of D-dimer level on cerebral embolism severity has not been examined. Thus, the purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in NVAF patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 h of symptom onset. We measured infarction volume from CT taken after 3 ± 1 days from the onset. Plasma D-dimer levels were measured at the time of admission. Relationships were analyzed between infarction volume and plasma D-dimer levels, cardiovascular risk factors, preadmission medications and admission conditions. We also assessed the influence of D-dimer level on functional outcome in patients with preadmission modified Rankin Scale (mRS) score of 0–1 and patients by tertile of D-dimer level (≤0.83, 0.83–2.16 and ≥2.16 µg/ml). Results: Infarction volume significantly correlated with D-dimer level (r = 0.309, p < 0.001), systolic blood pressure (r = 0.201, p = 0.026), diastolic blood pressure (r = 0.283, p = 0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r = 0.546, p < 0.001) and mRS score at discharge (r = 0.557, p < 0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume after adjusting for age, sex, current smoker or not, prothrombin time-international normalized ratio ≥1.6, diastolic blood pressure, CHADS₂ score and NIHSS score on admission. In patients with a preadmission mRS score of 0–1 (n = 108), D-dimer level was significantly associated with NIHSS score at admission (r = 0.318, p < 0.001) and mRS score at discharge (r = 0.310, p = 0.001). Patients in the highest D-dimer tertile group showed worse outcome than those in the middle (p = 0.041) and lowest (p < 0.001) tertiles. Conclusions: Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.

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“…In the study of Klok et al, a D-dimer cut-off level of >3,000 lg/l FEU was a strong predictor for the two-week mortality rate [28]. For determination of D-dimer concentrations, we have used the Tinaquant 1 assay.…”

Section: Discussionmentioning

confidence: 99%

“…The cut-off levels for D-dimer were based on previous studies in which D-dimer with a cut-off level >3,000 lg/l FEU was a strong predictor for short-term [28,29]. The chosen cut-off level for NT-proBNP of >500 pg/ml was based on our previous study in which outpatient treatment of PE-patients was based on NT-proBNP levels <500 pg/ml [30].…”

Section: Prognostic Model For Adverse Clinical Eventsmentioning

confidence: 99%

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

et al. 2011

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Risk stratification of patients with PE has gained interest in terms of the identification of patients in whom treatment on an outpatient base can be considered. Previous studies are of limited value due to their focus on adverse clinical events within several months after diagnosis of PE. We developed a prognostic model, based on easily accessible, clinical, and laboratory parameters, to predict adverse events during the first 10 days after the diagnosis of acute PE. We have analyzed the data of 210 outpatients with confirmed PE. Collected data included medical history, pulse rate, blood pressure, NT-proBNP, and D-dimer concentrations. The primary outcome was the occurrence of adverse clinical events in a 10 day follow-up period. Our final prognostic model to predict short-term adverse events consists of NT-proBNP levels, D-dimer concentrations, pulse rate, and the occurrence of active malignancy; the total score ranges from 0 to 37 points. Patients with a low score (no active malignancy, pulse rate <90 bpm, NT-proBNP <500 pg/ml, and D-dimer <3,000 lg/l FEU) have a 10-day adverse event risk <1.5%. This risk increases to over 30% in patients with a maximum score, based on high pulse rate, D-dimer concentrations, and NT-proBNP levels. Our prognostic model, once prospectively validated in an independent sample of patients, can be used in the early risk stratification of PE to estimate the risk of adverse events and to differentiate between candidates for in-or out-hospital treatment. Am. J. Hematol. 86:646-649, 2011. V

show abstract

High D‐dimer level is associated with increased 15‐d and 3 months mortality through a more central localization of pulmonary emboli and serious comorbidity

Cited by 61 publications

References 15 publications

D‐dimer levels and 15‐day outcome in acute pulmonary embolism. Findings from the RIETE Registry

D‐dimer levels and 15‐day outcome in acute pulmonary embolism. Findings from the RIETE Registry

Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

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