scholarly journals Screening for Pulmonary Embolism with a D-Dimer Assay: Do we Still Need to Assess Clinical Probability as Well?

2005 ◽  
Vol 98 (2) ◽  
pp. 54-58 ◽  
Author(s):  
Christopher J Hammond ◽  
Tajek B Hassan
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Retrospective Analysis ◽  
Emergency Departments ◽  
Latex Agglutination ◽  
Agglutination Assay ◽  
Clinical Risk ◽  
Clinical Probability ◽  
D Dimer ◽  
Latex Agglutination Assay

Clinical risk stratification and D-dimer assay can be of use in excluding pulmonary embolism in patients presenting to emergency departments but many D-dimer assays exist and their accuracy varies. We used clinical risk stratification combined with a quantitative latex-agglutination D-dimer assay to screen patients before arranging further imaging if required. Retrospective analysis of a sequential series of 376 patients revealed that no patient with a D-dimer of <275 ng/mL was diagnosed with pulmonary embolism, irrespective of clinical probability. We conclude that a latex-agglutination assay could be used to exclude pulmonary embolism without the necessity for clinical risk stratification. If these findings are borne out by further work, D-dimer strategies to exclude pulmonary embolism could substantially reduce imaging workload.

scholarly journals Specificity of Quantitative Latex Agglutination Assay for D-dimer in Exclusion of Pulmonary Embolism in the Emergency Department

2013 ◽  
Vol 20 (8) ◽  
pp. 807-812 ◽  
Author(s):  
Paul D. Stein ◽  
Fadi Matta ◽  
Michel J. Sabra ◽  
Christopher Tana ◽  
Andrew Gough ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Latex Agglutination ◽  
Agglutination Assay ◽  
D Dimer ◽  
Latex Agglutination Assay

Usefulness of a latex agglutination assay for FDP D-dimer to demonstrate the presence of postmortem blood

2005 ◽  
Vol 119 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Koichi Sakurada ◽  
Ikuko Sakai ◽  
Kazumasa Sekiguchi ◽  
Tomoko Shiraishi ◽  
Hiroshi Ikegaya ◽  
...  
Keyword(s):  
Latex Agglutination ◽  
Agglutination Assay ◽  
Postmortem Blood ◽  
D Dimer ◽  
Latex Agglutination Assay

A latex agglutination assay for D dimer: evaluation and application to the diagnosis of thrombotic disease.

1987 ◽  
Vol 33 (10) ◽  
pp. 1837-1840 ◽  
Author(s):  
C J Hillyard ◽  
A S Blake ◽  
K Wilson ◽  
D B Rylatt ◽  
S Miles ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Degradation Products ◽  
Reference Interval ◽  
Latex Agglutination ◽  
Agglutination Assay ◽  
Fibrin Degradation Products ◽  
Pathological Conditions ◽  
D Dimer ◽  
Latex Agglutination Assay ◽  
Apparently Healthy

Abstract Although latex agglutination assays have been used for some years to diagnose thrombotic disorders, only recently has it been possible to measure specifically the products of fibrin breakdown in the presence of fibrinogen degradation products, by using monoclonal antibodies. We have evaluated a preparation of latex particles coupled to the monoclonal antibody DD-3B6/22, which is specific for cross-linked fibrin degradation products (XDP) and allows accurate discrimination between normal and pathological conditions. Of samples from 515 apparently healthy volunteers, 97.7% failed to agglutinate the latex; the normal reference interval for XDP determined by enzyme immunoassay was less than 78-320 micrograms/L. The use of different anticoagulants with or without the addition of a protease inhibitor had no significant effects on the results of the latex assay. The latex preparation provides a useful, rapid diagnostic tool for assaying small numbers of samples or as an emergency test.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

scholarly journals Wells’ Score in Diagnosis of Pulmonary Embolism in Patient with Thrombocytopenia: A Case Report

2019 ◽  
Vol 20 (3) ◽  
pp. 281-285
Author(s):  
Dragan Panic ◽  
Andreja Todorovic ◽  
Milica Stanojevic ◽  
Violeta Iric Cupic
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Acute Pulmonary Embolism ◽  
Pretest Probability ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Clinical Probability ◽  
Wells Score ◽  
D Dimer

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.

Sign in / Sign up

Export Citation Format

Share Document