scholarly journals Routine screening for pulmonary embolism in COVID-19 patients at the emergency department: impact of D-dimer testing followed by CTPA

2021 ◽  
Author(s):  
Daniël A. Korevaar ◽  
Ilayda Aydemir ◽  
Maartje W. Minnema ◽  
Kaoutar Azijli ◽  
Ludo F. Beenen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Considerable Proportion ◽  
University Hospitals ◽  
Screening Algorithm ◽  
Increased Risk ◽  
Complete Study ◽  
D Dimer

AbstractCOVID-19 patients have increased risk of pulmonary embolism (PE), but symptoms of both conditions overlap. Because screening algorithms for PE in COVID-19 patients are currently lacking, PE might be underdiagnosed. We evaluated a screening algorithm in which all patients presenting to the ED with suspected or confirmed COVID-19 routinely undergo D-dimer testing, followed by CT pulmonary angiography (CTPA) if D-dimer is ≥ 1.00 mg/L. Consecutive adult patients presenting to the ED of two university hospitals in Amsterdam, The Netherlands, between 01-10-2020 and 31-12-2020, who had a final diagnosis of COVID-19, were retrospectively included. D-dimer and CTPA results were obtained. Of 541 patients with a final diagnosis of COVID-19 presenting to the ED, 25 (4.6%) were excluded because D-dimer was missing, and 71 (13.1%) because they used anticoagulation therapy. Of 445 included patients, 185 (41.6%; 95%CI 37.0–46.3) had a D-dimer ≥ 1.00 mg/L. CTPA was performed in 169 of them, which showed PE in 26 (15.4%; 95%CI 10.3–21.7), resulting in an overall detection rate of 5.8% (95%CI 3.9–8.4) in the complete study group. In patients with and without PE at CTPA, median D-dimer was 9.84 (IQR 3.90–29.38) and 1.64 (IQR 1.17–3.01), respectively (p < 0.001). PE prevalence increased with increasing D-dimer, ranging from 1.2% (95%CI 0.0–6.4) if D-dimer was 1.00–1.99 mg/L, to 48.6% (95%CI 31.4–66.0) if D-dimer was ≥ 5.00 mg/L. In conclusion, by applying this screening algorithm, PE was identified in a considerable proportion of COVID-19 patients. Prospective management studies should assess if this algorithm safely rules-out PE if D-dimer is < 1.00 mg/L.

scholarly journals D-dimer negative pulmonary embolism

2018 ◽  
Vol 5 (2) ◽  
pp. 429
Author(s):  
Dhananjaya M. ◽  
Kirankumar Meti ◽  
Rajendrakumar Parakh
Keyword(s):  
Pulmonary Embolism ◽  
Tertiary Care ◽  
Safety Margin ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Care Hospital ◽  
Ct Pulmonary Angiography ◽  
The Mean ◽  
D Dimer

Background: Pulmonary embolism (PE), is one of the major cardiovascular causes of death. Pulmonary embolus (PE) can be fatal but is often treatable if recognized early. Unfortunately, the clinical presentation of PE is often variable and misleading mimicking other illnesses and hence known as "the Great Masquerader," making diagnosis difficult. The D-dimer assay has recently come into favour as a method to exclude PE; however, this test has an acceptable safety margin only in low-risk populations.Methods: Present study included 35 patients with clinical suspicion of pulmonary embolism admitted at the tertiary care hospital of North Karnataka during the period from October 2016 to September 2017. Patients were classified according to final diagnosis by CT Pulmonary Angiography into 28 cases positive for PE (80%) and 7 cases negative for PE (20%).Results: Present study included 35 cases suspected to have PE (26 males and 9 females). Their age ranged from 33 to 72 years, with a mean age 48.9 ±14.2 years. 28 cases positive for PE (80%) and 7 cases negative for PE (20%). The mean age of positive and negative PE cases was 48.1±11.2 and 46.4±8.8 respectively. Results of D-dimer test were positive in 10 cases (35.7%) and were negative in 18 cases (61.3 %) of PE.Conclusions: This report highlights the risk of misdiagnosing PE if relying solely on ELISA D-dimer for exclusion. This report documents the presentation of PE despite having unremarkable ELISA D-dimer measurements and highlights the importance of clinical suspicion.

Diagnostic Performance of D-dimer in Predicting Pulmonary Embolism in Tuberculosis Pleural Effusion Patients.

2020 ◽  
Author(s):  
Xiao-Ming Li ◽  
Ya-Jing Qin ◽  
Wen-Jing Ye ◽  
Xi Chen ◽  
De-Zhi Sun ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pleural Effusion ◽  
Diagnostic Performance ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Reactive Protein ◽  
Imaging Results ◽  
Compression Ultrasound ◽  
Disease Hospital ◽  
D Dimer

Abstract Background: Tuberculosis pleural effusion patients always have elevated D-dimer levels. How D-dimer performance in predicting pulmonary embolism in TPE population is unclear. The aim of this study was to assess the diagnostic performance of D-dimer for pulmonary embolism in TPE population and explore the potential mechanism of PE in TPE patients.Methods: We retrospectively analyzed patients who were admitted to Xinhua hospital and Weifang Respiratory Disease Hospital with a final diagnosis of TPE between March 2014 and January 2020. Data including demographics, history, symptoms, D-dimer, C-reactive protein (CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR) as well as the cytokines such as IL-6, IL-8, TNF-α, IL-2 receptor of the first blood test, imaging results including computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) with Doppler were collected and analyzed. Results: 248 patients (male=170, female=78) at the age of 43±20.6 years were final included in this study. Elevated D-dimer (≥0.5mg/L) was detected in 186/248 (75%) patients. 150 patients received CTPA examination. PE was diagnosed in 29/150 (19.3%) patients. Among the TPE population, PE patients had significantly higher DD level than that of non-PE patients (2.26±0.96 mg/L VS 1.06±0.73 mg/L) (P＜0.05). An optimized cut off value for D-dimer in predicting PE in TPE was 1.18 mg/L, with a sensitivity of 89.7% and a specificity of 77.8 % ( area under curve was 0.893; 95% CI: 0.839-0.947; P＜0.01). PE patients had lower median WBC and IL-8 values (5.14Ⅹ109/L VS 6.1Ⅹ109/L, P＜0.05 ; 30.2 pg/ml VS 89.7 pg/ml, P＜0.05) but higher median IL-2 receptor value (1964.8 pg/ml VS 961.2 pg/ml, P＜0.01) than that of non-PE patients.Conclusions: D-dimer is still an objective biomarker to predict PE in TPE patients. In order to avoid unnecessary radiological test, the cut off value of D-dimer in TPE patients should be set at 1.18 mg/L. In addition, the imbalance of prothrombotic and antithrombotic cytokines may partly attribute to the formation of pulmonary embolus in TPE patients.

scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

scholarly journals Clinical Outcomes of Pulmonary Embolism in Mexican Patients With COVID-19

2021 ◽  
Vol 27 ◽  
pp. 107602962110089
Author(s):  
Luis O. Bobadilla-Rosado ◽  
Santiago Mier y Teran-Ellis ◽  
Gabriel Lopez-Pena ◽  
Javier E. Anaya-Ayala ◽  
Carlos A. Hinojosa
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Coagulation Abnormalities ◽  
Survivor Group ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit ( P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group ( P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

scholarly journals Pulmonary embolism severity before and during the COVID-19 pandemic

2021 ◽  
pp. 20210264
Author(s):  
Vicky Tilliridou ◽  
Rachael Kirkbride ◽  
Rebecca Dickinson ◽  
James Tiernan ◽  
Guo Liang Yong ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Frequency ◽  
Pulmonary Angiography ◽  
Demographic Information ◽  
Right Heart ◽  
Computed Tomography Pulmonary Angiography ◽  
Health Records ◽  
Retrospective Audit ◽  
Increased Risk ◽  
Age And Sex

Objectives: Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. Methods: In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. Results: In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). Conclusion: During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. Advances in knowledge: During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.

scholarly journals THE ASSOCIATION BETWEEN D-DIMER AND DEEP VEIN THROMBOSIS LOCATION AND ITS ABILITY TO PREDICT PULMONARY EMBOLISM, a retrospective pilot study

2019 ◽  
Author(s):  
Sarah Ali Althomali ◽  
Adel S. Alghamdi ◽  
Tareef H. Gnoot ◽  
Mohammad A. Alhassan ◽  
Abdullatif H. Ajaimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Risk Group ◽  
Great Role ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Risk Patients ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
D Dimer

Abstract Background In lower limb deep vein thrombosis; it is important to identify proximal from distal deep vein thrombosis as it carries the highest risk of pulmonary embolism. It is known that D-dimer has a great role in deep vein thrombosis diagnosis. Yet, the use of D-dimer to predict the location of deep vein thrombosis and the risk of pulmonary embolism in deep vein thrombosis patients has not been investigated before. Objective To address the correlation between D-dimer and the location of deep vein thrombosis and to study the efficacy of D-dimer to predict risk of PE in patients with proximal or extensive deep vein thrombosis. Method We included 110 consecutive patients who were hospitalized with the diagnosis of deep vein thrombosis, with or without a concomitant diagnosis of PE, and with D-dimer measured at initial presentation. We categorized the location of deep vein thrombosis as: distal, proximal, and extensive. In the analysis, patients were grouped into high-risk (patients with Proximal or Extensive deep vein thrombosis and pulmonary embolism) and low risk group (patients without pulmonary embolism). Results There was no significant association between D-dimer level and the location of deep vein thrombosis (p=0.519). However, D-dimer level was greater among patients with pulmonary embolism (9.6mg/L) than among patients without pulmonary embolism (7.4mg/L), (p=0.027). D-dimer was a significant predictor of pulmonary embolism as patients with proximal or extensive deep vein thrombosis had 8-folds increased risk of pulmonary embolism than patients with D-dimer less than 4.75mg/L (OR=7.9, p=0.013). Conclusion Though D-dimer was not significantly associated with the location of deep vein thrombosis, it was a significant predictor of pulmonary embolism in patients hospitalized with proximal or extensive deep vein thrombosis.

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