How we manage a high D-dimer

Franchini, Massimo; Focosi, Daniele; Pezzo, Mario Piergiulio; Mannucci, Pier Mannuccio

doi:10.3324/haematol.2023.283966

Cited by 2 publications

(1 citation statement)

References 88 publications

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“…A recent British review suggests a trough of 20 IU/dL for oral anticoagulation 36 . In 2023, 2 more expert opinion articles have been published on the topic 37,38 …”

Section: Section 1: General Considerationsmentioning

confidence: 99%

Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance

et al. 2023

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Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.

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“…A recent British review suggests a trough of 20 IU/dL for oral anticoagulation 36 . In 2023, 2 more expert opinion articles have been published on the topic 37,38 …”

Section: Section 1: General Considerationsmentioning

confidence: 99%

Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance

et al. 2023

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D-Dimer and the Short-Term Prognosis of Patients with Subarachnoid Hemorrhage: A Meta-Analysis

Shang,

2024

Eur Neurol

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Introduction: Elevated plasma D-dimer has been observed in acute phase of subarachnoid hemorrhage (SAH), while a quantitative evaluation for the association between D-dimer level and prognosis of SAH remains lacking. The aim of the meta-analysis was to investigate the potential predictive role of D-dimer for the short-term functional outcome of patients with SAH. Methods: Relevant observational studies were retrieved by search of PubMed, Web of Science, Embase, Wanfang and CNKI. A poor functional was generally defined as the Glasgow Outcome Scale (1~3) or the modified Rankin Scale (≥3). A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity. Results: Eleven studies involving 3748 patients with SAH were included. Among them, 1131 patients (30.2%) developed poor functional outcome within 6 months. The pooled results showed that a higher plasma D-dimer at admission was associated with a higher risk of poor functional outcome during follow-up (odds ratio per 1 mg/L increment of D-dimer: 1.65, 95% CI: 1.49 to 1.82, p < 0.001; I2 = 0%). Sensitivity analysis by excluding one study at a time showed similar results. Subgroup analyses suggested that the association between D-dimer and poor functional outcome of patients with SAH was not significantly affected by study design, country, mean age, proportion of men, follow-up duration, methods for defining poor outcome, study quality scores, timing of D-dimer measurement, or the publication year. Conclusion: A high plasma D-dimer at admission is associated with a poor short-term functional outcome of patients with SAH.

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How we manage a high D-dimer

Cited by 2 publications

References 88 publications

Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance

Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance

D-Dimer and the Short-Term Prognosis of Patients with Subarachnoid Hemorrhage: A Meta-Analysis

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