Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy
The stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predicto...
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| Veröffentlicht in: | Thrombosis and haemostasis 2013-02, Vol.109 (2), p.181-186 |
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| creator | Poli, Daniela Cenci, Caterina Antonucci, Emilia Grifoni, Elisa Arcangeli, Chiara Prisco, Domenico Abbate, Rosanna Miniati, Massimo |
| description | The stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO. |
| doi_str_mv | 10.1160/TH12-07-0534 |
| format | Article |
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Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO.</description><identifier>ISSN: 0340-6245</identifier><identifier>EISSN: 2567-689X</identifier><identifier>DOI: 10.1160/TH12-07-0534</identifier><identifier>PMID: 23196319</identifier><identifier>CODEN: THHADQ</identifier><language>eng</language><publisher>Stuttgart: Schattauer Verlag für Medizin und Naturwissenschaften</publisher><subject>Administration, Oral ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants - administration & dosage ; Biological and medical sciences ; Biomarkers - blood ; Blood Coagulation, Fibrinolysis and Cellular Haemostasis ; Blood coagulation. Blood cells ; D-dimer ; Drug Administration Schedule ; Female ; Femoral Vein - diagnostic imaging ; Fibrin Fibrinogen Degradation Products - metabolism ; Follow-Up Studies ; Fundamental and applied biological sciences. Psychology ; Hematologic and hematopoietic diseases ; Humans ; Lung - blood supply ; Male ; Medical sciences ; Middle Aged ; Molecular and cellular biology ; perfusion defects ; Perfusion Imaging ; Platelet diseases and coagulopathies ; Pneumology ; Popliteal Vein - diagnostic imaging ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Pulmonary Circulation ; pulmonary embolism ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - diagnostic imaging ; Pulmonary Embolism - drug therapy ; Pulmonary Embolism - physiopathology ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Recurrence ; Risk Assessment ; Risk Factors ; Time Factors ; Ultrasonography ; Up-Regulation ; Venous Thromboembolism - blood ; Venous Thromboembolism - diagnosis ; Venous Thromboembolism - diagnostic imaging ; Venous Thromboembolism - drug therapy ; Venous Thromboembolism - physiopathology ; Young Adult</subject><ispartof>Thrombosis and haemostasis, 2013-02, Vol.109 (2), p.181-186</ispartof><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-2584fe46101c0786feb1f8a10f32e82d72761921a6f2da3b8c5ecd1d58b0a24a3</citedby><cites>FETCH-LOGICAL-c460t-2584fe46101c0786feb1f8a10f32e82d72761921a6f2da3b8c5ecd1d58b0a24a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://www.schattauer.de/typo3temp/pics/cover-1699_cf8bbebab7.jpg</thumbnail><linktopdf>$$Uhttps://www.thieme-connect.de/products/ejournals/pdf/10.1160/TH12-07-0534.pdf$$EPDF$$P50$$Gthieme$$H</linktopdf><linktohtml>$$Uhttps://www.thieme-connect.de/products/ejournals/html/10.1160/TH12-07-0534$$EHTML$$P50$$Gthieme$$H</linktohtml><link.rule.ids>314,780,784,3018,27924,27925,54559,54560</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26845848$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23196319$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poli, Daniela</creatorcontrib><creatorcontrib>Cenci, Caterina</creatorcontrib><creatorcontrib>Antonucci, Emilia</creatorcontrib><creatorcontrib>Grifoni, Elisa</creatorcontrib><creatorcontrib>Arcangeli, Chiara</creatorcontrib><creatorcontrib>Prisco, Domenico</creatorcontrib><creatorcontrib>Abbate, Rosanna</creatorcontrib><creatorcontrib>Miniati, Massimo</creatorcontrib><title>Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy</title><title>Thrombosis and haemostasis</title><addtitle>Thromb Haemost</addtitle><description>The stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO.</description><subject>Administration, Oral</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Blood Coagulation, Fibrinolysis and Cellular Haemostasis</subject><subject>Blood coagulation. Blood cells</subject><subject>D-dimer</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Femoral Vein - diagnostic imaging</subject><subject>Fibrin Fibrinogen Degradation Products - metabolism</subject><subject>Follow-Up Studies</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Lung - blood supply</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular and cellular biology</subject><subject>perfusion defects</subject><subject>Perfusion Imaging</subject><subject>Platelet diseases and coagulopathies</subject><subject>Pneumology</subject><subject>Popliteal Vein - diagnostic imaging</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Pulmonary Circulation</subject><subject>pulmonary embolism</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Pulmonary Embolism - drug therapy</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Recurrence</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Ultrasonography</subject><subject>Up-Regulation</subject><subject>Venous Thromboembolism - blood</subject><subject>Venous Thromboembolism - diagnosis</subject><subject>Venous Thromboembolism - diagnostic imaging</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>Venous Thromboembolism - physiopathology</subject><subject>Young Adult</subject><issn>0340-6245</issn><issn>2567-689X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1TAQRSMEoq-FHWvkDSsI2E7i5LGrCqVIlUCoSOysec64cUnsyONQ9RP4axyllBWLkcfS0Z2Ze4viheBvhVD83dWFkCVvS95U9aNiJxvVlqrb_3hc7HhV81LJujkqjoluOBeq3jdPiyNZib3KtSt-f3P0kwXLIpolRvQGmfNshuTQJ2K3Lg1sXsYpeIh3DKdDGB1N79nXiL0zyf1CFsOIq8SHsncTRga-3xTJ9QuMbMZoF3LBsx4tmqya23Hx14yM88ldR5iHu2fFEwsj4fP796T4fv7x6uyivPzy6fPZ6WVpasVTKZuutlgrwYXhbacsHoTtQHBbSexk38pWib0UoKzsoTp0pkHTi77pDhxkDdVJ8WbTNTEQRbR6jm7Kx2nB9eqoXh3VvNWroxl_ueHzcpiwf4D_WpiBV_cAkIHRRvDG0T9OdXVeucvc641Lg8MJ9U1Yos-H_m-s32gyA6QEC8YHyTTEkHOgPCVbrQfAKVCC9W-CT2tuGqIZcjbaES2oaUbjYNQT-IVMdHPSYs-bRtMQbvWQprH6A7qQujU</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Poli, Daniela</creator><creator>Cenci, Caterina</creator><creator>Antonucci, Emilia</creator><creator>Grifoni, Elisa</creator><creator>Arcangeli, Chiara</creator><creator>Prisco, Domenico</creator><creator>Abbate, Rosanna</creator><creator>Miniati, Massimo</creator><general>Schattauer Verlag für Medizin und Naturwissenschaften</general><general>Schattauer GmbH</general><general>Schattauer</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20130201</creationdate><title>Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy</title><author>Poli, Daniela ; Cenci, Caterina ; Antonucci, Emilia ; Grifoni, Elisa ; Arcangeli, Chiara ; Prisco, Domenico ; Abbate, Rosanna ; Miniati, Massimo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-2584fe46101c0786feb1f8a10f32e82d72761921a6f2da3b8c5ecd1d58b0a24a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Administration, Oral</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Blood Coagulation, Fibrinolysis and Cellular Haemostasis</topic><topic>Blood coagulation. Blood cells</topic><topic>D-dimer</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Femoral Vein - diagnostic imaging</topic><topic>Fibrin Fibrinogen Degradation Products - metabolism</topic><topic>Follow-Up Studies</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Lung - blood supply</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Molecular and cellular biology</topic><topic>perfusion defects</topic><topic>Perfusion Imaging</topic><topic>Platelet diseases and coagulopathies</topic><topic>Pneumology</topic><topic>Popliteal Vein - diagnostic imaging</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Pulmonary Circulation</topic><topic>pulmonary embolism</topic><topic>Pulmonary Embolism - blood</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - diagnostic imaging</topic><topic>Pulmonary Embolism - drug therapy</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Recurrence</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Ultrasonography</topic><topic>Up-Regulation</topic><topic>Venous Thromboembolism - blood</topic><topic>Venous Thromboembolism - diagnosis</topic><topic>Venous Thromboembolism - diagnostic imaging</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>Venous Thromboembolism - physiopathology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poli, Daniela</creatorcontrib><creatorcontrib>Cenci, Caterina</creatorcontrib><creatorcontrib>Antonucci, Emilia</creatorcontrib><creatorcontrib>Grifoni, Elisa</creatorcontrib><creatorcontrib>Arcangeli, Chiara</creatorcontrib><creatorcontrib>Prisco, Domenico</creatorcontrib><creatorcontrib>Abbate, Rosanna</creatorcontrib><creatorcontrib>Miniati, Massimo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poli, Daniela</au><au>Cenci, Caterina</au><au>Antonucci, Emilia</au><au>Grifoni, Elisa</au><au>Arcangeli, Chiara</au><au>Prisco, Domenico</au><au>Abbate, Rosanna</au><au>Miniati, Massimo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy</atitle><jtitle>Thrombosis and haemostasis</jtitle><addtitle>Thromb Haemost</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>109</volume><issue>2</issue><spage>181</spage><epage>186</epage><pages>181-186</pages><issn>0340-6245</issn><eissn>2567-689X</eissn><coden>THHADQ</coden><abstract>The stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO.</abstract><cop>Stuttgart</cop><pub>Schattauer Verlag für Medizin und Naturwissenschaften</pub><pmid>23196319</pmid><doi>10.1160/TH12-07-0534</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-6245 |
| ispartof | Thrombosis and haemostasis, 2013-02, Vol.109 (2), p.181-186 |
| issn | 0340-6245 2567-689X |
| language | eng |
| recordid | cdi_pascalfrancis_primary_26845848 |
| source | MEDLINE; Thieme Connect Journals |
| subjects | Administration, Oral Adolescent Adult Aged Aged, 80 and over Anticoagulants - administration & dosage Biological and medical sciences Biomarkers - blood Blood Coagulation, Fibrinolysis and Cellular Haemostasis Blood coagulation. Blood cells D-dimer Drug Administration Schedule Female Femoral Vein - diagnostic imaging Fibrin Fibrinogen Degradation Products - metabolism Follow-Up Studies Fundamental and applied biological sciences. Psychology Hematologic and hematopoietic diseases Humans Lung - blood supply Male Medical sciences Middle Aged Molecular and cellular biology perfusion defects Perfusion Imaging Platelet diseases and coagulopathies Pneumology Popliteal Vein - diagnostic imaging Predictive Value of Tests Prognosis Prospective Studies Pulmonary Circulation pulmonary embolism Pulmonary Embolism - blood Pulmonary Embolism - diagnosis Pulmonary Embolism - diagnostic imaging Pulmonary Embolism - drug therapy Pulmonary Embolism - physiopathology Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Recurrence Risk Assessment Risk Factors Time Factors Ultrasonography Up-Regulation Venous Thromboembolism - blood Venous Thromboembolism - diagnosis Venous Thromboembolism - diagnostic imaging Venous Thromboembolism - drug therapy Venous Thromboembolism - physiopathology Young Adult |
| title | Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy |
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