High D‐dimer levels increase the likelihood of pulmonary embolism
. Objective. To determine the utility of high quantitative D‐dimer levels in the diagnosis of pulmonary embolism. Methods. D‐dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thr...
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| Veröffentlicht in: | Journal of internal medicine 2008-08, Vol.264 (2), p.195-200 |
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| creator | Tick, L. W. Nijkeuter, M. Kramer, M. H. H. Hovens, M. M. C. Büller, H. R. Leebeek, F. W. G. Huisman, M. V. |
| description | .
Objective. To determine the utility of high quantitative D‐dimer levels in the diagnosis of pulmonary embolism.
Methods. D‐dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D‐dimer testing and computed tomography.
Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D‐dimer level, and increased fourfold with D‐dimer levels greater than 4000 ng mL−1 compared to levels between 500 and 1000 ng mL−1. Patients with D‐dimer levels higher than 2000 ng mL−1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D‐dimer levels were above 4000 ng mL−1, the observed pulmonary embolism prevalence was very high, independent of CDR score.
Conclusion. Strongly elevated D‐dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D‐dimer levels irrespective of CDR remains to be studied. |
| doi_str_mv | 10.1111/j.1365-2796.2008.01972.x |
| format | Article |
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Objective. To determine the utility of high quantitative D‐dimer levels in the diagnosis of pulmonary embolism.
Methods. D‐dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D‐dimer testing and computed tomography.
Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D‐dimer level, and increased fourfold with D‐dimer levels greater than 4000 ng mL−1 compared to levels between 500 and 1000 ng mL−1. Patients with D‐dimer levels higher than 2000 ng mL−1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D‐dimer levels were above 4000 ng mL−1, the observed pulmonary embolism prevalence was very high, independent of CDR score.
Conclusion. Strongly elevated D‐dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D‐dimer levels irrespective of CDR remains to be studied.</description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/j.1365-2796.2008.01972.x</identifier><identifier>PMID: 18452520</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Algorithms ; Biological and medical sciences ; Biomarkers - metabolism ; clinical decision rule ; diagnosis ; D‐dimer ; Female ; Fibrin Fibrinogen Degradation Products - metabolism ; General aspects ; high levels ; Humans ; Medical sciences ; Middle Aged ; Pneumology ; pulmonary embolism ; Pulmonary Embolism - diagnosis ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Treatment Outcome</subject><ispartof>Journal of internal medicine, 2008-08, Vol.264 (2), p.195-200</ispartof><rights>2008 Blackwell Publishing Ltd</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4482-e9d2dc445c97547a5a0c167fa45a6d1610d484f7e88d1819ad45e4d54eb57d683</citedby><cites>FETCH-LOGICAL-c4482-e9d2dc445c97547a5a0c167fa45a6d1610d484f7e88d1819ad45e4d54eb57d683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2796.2008.01972.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2796.2008.01972.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20513741$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18452520$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tick, L. W.</creatorcontrib><creatorcontrib>Nijkeuter, M.</creatorcontrib><creatorcontrib>Kramer, M. H. H.</creatorcontrib><creatorcontrib>Hovens, M. M. C.</creatorcontrib><creatorcontrib>Büller, H. R.</creatorcontrib><creatorcontrib>Leebeek, F. W. G.</creatorcontrib><creatorcontrib>Huisman, M. V.</creatorcontrib><creatorcontrib>Christopher Study Investigators</creatorcontrib><creatorcontrib>on behalf of the Christopher Study Investigators</creatorcontrib><title>High D‐dimer levels increase the likelihood of pulmonary embolism</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>.
Objective. To determine the utility of high quantitative D‐dimer levels in the diagnosis of pulmonary embolism.
Methods. D‐dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D‐dimer testing and computed tomography.
Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D‐dimer level, and increased fourfold with D‐dimer levels greater than 4000 ng mL−1 compared to levels between 500 and 1000 ng mL−1. Patients with D‐dimer levels higher than 2000 ng mL−1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D‐dimer levels were above 4000 ng mL−1, the observed pulmonary embolism prevalence was very high, independent of CDR score.
Conclusion. Strongly elevated D‐dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D‐dimer levels irrespective of CDR remains to be studied.</description><subject>Algorithms</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - metabolism</subject><subject>clinical decision rule</subject><subject>diagnosis</subject><subject>D‐dimer</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products - metabolism</subject><subject>General aspects</subject><subject>high levels</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>pulmonary embolism</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, Spiral Computed</subject><subject>Treatment Outcome</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1OwzAQRi0EoqVwBeQN7BJsx3acDRIqPy0q6gbWlhtPqIvTlLiFdscROCMnIaEVbJmNR_KbmU8PIUxJTJu6mMU0kSJiaSZjRoiKCc1SFq_3UPf3Yx91SSZ4JBUjHXQUwowQmhBJDlGHKi6YYKSL-gP3PMXXXx-f1pVQYw9v4AN287wGEwAvp4C9ewHvplVlcVXgxcqX1dzUGwzlpPIulMfooDA-wMnu7aGn25vH_iAaje-G_atRlHOuWASZZbZpRZ6lgqdGGJJTmRaGCyMtlZRYrniRglKWKpoZywVwKzhMRGqlSnrofLt3UVevKwhLXbqQg_dmDtUqaJnxhHGaNKDagnldhVBDoRe1K5vImhLdCtQz3XrSrSfdCtQ_AvW6GT3d3VhNSrB_gztjDXC2A0zIjS9qM89d-OUYETRJmxA9dLnl3p2Hzb8D6Pvx8KFtk293IoxB</recordid><startdate>200808</startdate><enddate>200808</enddate><creator>Tick, L. W.</creator><creator>Nijkeuter, M.</creator><creator>Kramer, M. H. H.</creator><creator>Hovens, M. M. C.</creator><creator>Büller, H. R.</creator><creator>Leebeek, F. W. G.</creator><creator>Huisman, M. V.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell Science</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><scope>7X8</scope></search><sort><creationdate>200808</creationdate><title>High D‐dimer levels increase the likelihood of pulmonary embolism</title><author>Tick, L. W. ; Nijkeuter, M. ; Kramer, M. H. H. ; Hovens, M. M. C. ; Büller, H. R. ; Leebeek, F. W. G. ; Huisman, M. V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4482-e9d2dc445c97547a5a0c167fa45a6d1610d484f7e88d1819ad45e4d54eb57d683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Algorithms</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - metabolism</topic><topic>clinical decision rule</topic><topic>diagnosis</topic><topic>D‐dimer</topic><topic>Female</topic><topic>Fibrin Fibrinogen Degradation Products - metabolism</topic><topic>General aspects</topic><topic>high levels</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>pulmonary embolism</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, Spiral Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tick, L. W.</creatorcontrib><creatorcontrib>Nijkeuter, M.</creatorcontrib><creatorcontrib>Kramer, M. H. H.</creatorcontrib><creatorcontrib>Hovens, M. M. C.</creatorcontrib><creatorcontrib>Büller, H. R.</creatorcontrib><creatorcontrib>Leebeek, F. W. G.</creatorcontrib><creatorcontrib>Huisman, M. V.</creatorcontrib><creatorcontrib>Christopher Study Investigators</creatorcontrib><creatorcontrib>on behalf of the Christopher Study Investigators</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><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tick, L. W.</au><au>Nijkeuter, M.</au><au>Kramer, M. H. H.</au><au>Hovens, M. M. C.</au><au>Büller, H. R.</au><au>Leebeek, F. W. G.</au><au>Huisman, M. V.</au><aucorp>Christopher Study Investigators</aucorp><aucorp>on behalf of the Christopher Study Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High D‐dimer levels increase the likelihood of pulmonary embolism</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2008-08</date><risdate>2008</risdate><volume>264</volume><issue>2</issue><spage>195</spage><epage>200</epage><pages>195-200</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract>.
Objective. To determine the utility of high quantitative D‐dimer levels in the diagnosis of pulmonary embolism.
Methods. D‐dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D‐dimer testing and computed tomography.
Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D‐dimer level, and increased fourfold with D‐dimer levels greater than 4000 ng mL−1 compared to levels between 500 and 1000 ng mL−1. Patients with D‐dimer levels higher than 2000 ng mL−1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D‐dimer levels were above 4000 ng mL−1, the observed pulmonary embolism prevalence was very high, independent of CDR score.
Conclusion. Strongly elevated D‐dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D‐dimer levels irrespective of CDR remains to be studied.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18452520</pmid><doi>10.1111/j.1365-2796.2008.01972.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Algorithms Biological and medical sciences Biomarkers - metabolism clinical decision rule diagnosis D‐dimer Female Fibrin Fibrinogen Degradation Products - metabolism General aspects high levels Humans Medical sciences Middle Aged Pneumology pulmonary embolism Pulmonary Embolism - diagnosis Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Sensitivity and Specificity Tomography, Spiral Computed Treatment Outcome |
| title | High D‐dimer levels increase the likelihood of pulmonary embolism |
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