Quantitative Plasma D-dimer Levels Among Patients Undergoing Pulmonary Angiography for Suspected Pulmonary Embolism

Goldhaber, Samuel Z.; Simons, Grant R.; Elliott, C. Gregory; Haire, William D.; Toltzis, Robert J.; Blacklow, Stephen C.; Doolittle, Marc H.; Weinberg, Douglas S.

doi:10.1001/jama.1993.03510230057035

Cited by 108 publications

(22 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, D-dimer was the most sensitive biomarker for APE, with 85.1% sensitivity and 78.8% negative predictive value. Although D-dimer values may be used to exclude PE in patients with either a low or a moderate probability of PE, measurement of D-dimer is not useful for confirming PE [22][23][24][25]. Copeptin may be used to support the need for further investigations with moderate specificity and positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of serum copeptin levels in an acute pulmonary embolism

et al. 2016

View full text Add to dashboard Cite

D-dimer (r = 0.315, p = 0.003) and troponin I (r = 0.300, p = 0.004) and inversely correlated with arterial oxygen saturations (r = -0.533, p < 0001). When the correlation of copeptin with right ventricular dysfunction parameters was investigated, it was significantly inversely correlated with the tricuspid annular plane systolic excursion (r = -0.521, p < 0.001) and positively cor related with right to left ventricle ratio (r = 0.329, p = 0.024). Copeptin (OR 1.836, p = 0.008) (Cardiol J 2016; 23, 1: 42-50)

show abstract

Section: Discussionmentioning

confidence: 99%

The diagnostic value of serum copeptin levels in an acute pulmonary embolism

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Smooth muscle myosin heavy chain 9 and elastin 10 have been proposed as specific markers of AAD, but rapid measurement systems are not clinically available. In general, DD is used in cases of suspected coagulation activation and in all clinical conditions with ongoing fibrinolysis, such as disseminated intravascular coagulation, 11 liver cirrhosis, 12 fulminant hepatitis, 13 malignancy, 14 burn, 15 aortic aneurysm, 16 pulmonary embolism, [17][18][19] deep vein thrombosis, 4,5,20,21 and acute coronary syndrome. 22,23 D-dimer is a useful diagnostic marker for pulmonary embolism and deep vein thrombosis because of the high negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Bedside D-Dimer Assay (Cardiac D-Dimer) for Screening of Clinically Suspected Acute Aortic Dissection

Akutsu

Sato

Yamamoto

et al. 2005

Circ J

View full text Add to dashboard Cite

cute aortic dissection (AAD) can be fatal and should be diagnosed as early as possible. Without treatment, mortality increases by 1% per hour during the first 48 h. 1 Acute aortic dissection has traditionally been diagnosed by computed tomography (CT) because a rapid laboratory test has not been available. However, if the possibility of AAD could be ruled out, contrast-enhanced CT, which is time-consuming and impairs renal function with contrast media, would be unnecessary. Both the coagulation and fibrinolytic systems are reportedly activated in cases of AAD. 2 Weber et al found that assay of D-dimer (DD), a specific degradation product of cross-linked fibrin, had 100% sensitivity but only 69% specificity for detection of AAD. 3 A rapid bedside DD assay (Cardiac D-dimer, Roche Diagnostics, Mannheim, Germany) was recently developed for detection of pulmonary embolism and deep vein thrombosis. 4,5 One characteristic of patients with AAD is elevated systolic blood pressure, 1 and we hypothesized that elevated blood pressure could serve as a diagnostic indicator in cases of suspected AAD. Therefore, the first goal of the present study was to show the utility of rapid bedside DD assay in the detection of AAD. The second goal was to clarify whether positive predictive value could be increased if the rapid bedside DD assay value and blood pressure reading upon admission were used in combination. Circulation Journal Vol.69, April 2005 Methods PatientsThe study group included consecutive patients in whom AAD was suspected or not ruled out, who were admitted to the coronary care unit during the period November 2002 through June 2004 and in whom the DD level was determined by rapid bedside assay. Acute aortic dissection was suspected in patients with sudden onset of chest and/or back pain and no definitive electrocardiographic findings of Background A rapid laboratory test for diagnosis of acute aortic dissection (AAD) has not been available. We performed this prospective study to determine the utility of a rapid bedside D-dimer (DD) assay for detection of AAD. Methods and ResultsPatients with suspected AAD were recruited and their DD levels were measured by rapid bedside assay. They were divided into 2 groups according to enhanced computed tomography findings: an AAD group (n=30) and a non-AAD group (n=48). The median DD level was higher in the AAD group (1.80 g/ml) than in the non-AAD group (0.42 g/ml) (p=0.000). The rapid bedside DD assay showed 100% sensitivity, 54% specificity, 58% positive predictive value and 100% negative predictive value for detection of AAD with a normal DD level of up to 0.5 g/ml. The combination of DD level >0.5 g/ml and systolic blood pressure ≥180 mmHg showed 86% positive predictive value for detection of AAD.Conclusions We conclude that the rapid bedside DD assay is a highly sensitive method for early exclusion of AAD in patients with chest and/or back pain suggestive of AAD. Acute aortic dissection is highly probable if a rapid DD assay shows the elevated DD level with systolic blood press...

show abstract

“…The D-dimer concentration tends to be elevated in many diseases, such as pulmonary embolism, 32 deep venous thrombosis, 33,34 disseminated intravascular coagulation, 35 cancer, 36 ventricular tachycardia and fibrillation, 23 congestive heart failure 23,37 and atrial fibrillation. 38,39 Therefore, further investigation is necessary to clarify whether the Ddimer assay can differentiate AADa from these diseases, but we believe that by setting an appropriate cutoff value for the assay AADa can be differentiated from AMI in the emergency department before initiation of reperfusion therapy, even if the D-dimer value is not diagnostic for AADa because of its lack of specificity.…”

Section: D-dimer Concentrationmentioning

confidence: 99%