Combined measurement of factor XIII and D-dimer is helpful for differential diagnosis in patients with suspected pulmonary embolism

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Ning Tang ◽  
Ziyong Sun ◽  
Dengju Li ◽  
Jun Yang ◽  
Shiyu Yin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pulmonary Embolism ◽  
Factor Xiii ◽  
Coagulation Factor ◽  
Suspected Pulmonary Embolism ◽  
Coronary Syndrome ◽  
Single Center Study ◽  
Wells Score ◽  
D Dimer ◽  
Rule Out

AbstractBackground:D-dimer has been used to rule out pulmonary embolism (PE). Based on previous reports of decreased concentrations of coagulation factor XIII (FXIII) in venous thromboembolism, and no change in FXIII concentration in patients with acute cardiovascular disease, we evaluated the benefit of simultaneously measuring D-dimer and FXIII concentrations for diagnosing PE.Methods:In this prospective single-center study, we enrolled 209 patients initially suspected of having PE, and measured their D-dimer and FXIII concentrations. Forty-one patients were diagnosed with PE and 168 with other final diagnoses, including acute coronary syndrome (ACS); aortic dissection (AD); spontaneous pneumothorax (SP); other respiratory, heart, digestive and nervous diseases; and uncertain diagnoses.Results:Patients with PE had significantly higher D-dimer and lower FXIII concentrations than did patients without PE. Combined D-dimer and FXIII measurements provided a higher positive predictive value (76.6%) for PE than single tests, especially in patients with Wells score >4.0 (89.3%). Specifically, patients with AD or ACS showed higher FXIII concentrations and mean platelet volumes than did patients with PE or SP, and patients with PE and AD had higher D-dimer concentrations than did other patients. At the thresholds of 69.0% for FXIII and 1.10 μg/mL for D-dimer, 123/151 patients (81.5%) with serious diseases (PE, AD, ACS and SP) were correctly distinguished.Conclusions:Combined measurement of D-dimer and FXIII helps distinguish PE from serious diseases with similar symptoms and appears to relate to increased FXIII release from active platelets in cardiovascular disease.

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

From dyspnea to pulmonary embolism

2009 ◽  
Vol 66 (9) ◽  
pp. 643-647 ◽  
Author(s):  
Arnaud Perrier
Keyword(s):  
Pulmonary Embolism ◽  
Large Body ◽  
Prediction Rule ◽  
Clinical Suspicion ◽  
First Episode ◽  
Left Heart Failure ◽  
Coronary Syndrome ◽  
Clinical Probability ◽  
D Dimer ◽  
Rule Out

Pulmonary embolism (PE) is often evoked in patients with new-onset or worsening dyspnea, especially when it is associated with pleuritic chest pain. However, the prevalence of PE in patients with a clinical suspicion ranges from 20 % to as low as 5 %. Unfortunately, what exactly constitutes a clinical suspicion of PE in a patient with dyspnea can not be accurately standardized. The presence of risk factors for venous thromboembolism should prompt the search for PE. However, their absence does not rule out PE as the cause of the patient’s symptoms, since around 30 % of patients with a first episode of PE have no risk or precipitating factors. Once PE is suspected, the diagnostic workup can be standardized and based on a large body of evidence, combining clinical assessment by a prediction rule, D-dimer measurement and CT angiography in patients with an elevated D-dimer level or a high clinical probability of PE. Patients with obvious alternative diagnoses such as acute left heart failure, pneumonia or acute coronary syndrome should not be investigated for PE.

Role of blood coagulation factor XIII in patients with acute pulmonary embolism. Correlation of factor XIII antigen levels with pulmonary occlusion rate, fibrinogen, D-dimer, and clot firmness

2003 ◽  
Vol 90 (09) ◽  
pp. 434-438 ◽  
Author(s):  
Nils Kucher ◽  
Verena Schroeder ◽  
Hans Kohler
Keyword(s):  
Pulmonary Embolism ◽  
Factor Xiii ◽  
Acute Pulmonary Embolism ◽  
Coagulation Factor ◽  
Helical Computed Tomography ◽  
Coagulation Factor Xiii ◽  
A Subunit ◽  
Occlusion Rate ◽  
D Dimer

SummaryIn patients with acute pulmonary embolism (PE), pulmonary occlusion rate is directly related to D-dimer and inversely related to fibrinogen levels. The role of coagulation factor XIII (FXIII) levels in acute venous thromboembolism is not known. A total of 120 consecutive patients with suspected PE and VIDAS D-dimer levels >500 μg/L were investigated by helical computed tomography (CT). Pulmonary occlusion rate was assessed by CT using the modified Miller index. D-dimer, fibrinogen, and FXIII A- and B-subunit antigen levels were taken on admission. Thrombelastography (TEG) was performed in a subset of patients (n=12).The 71 patients with PE had lower FXIII A-subunit levels than the 49 patients with excluded PE (78.6±24.5% vs. 91.3±28.8%, p=0.01). In both groups, FXIII A-subunit was inversely related to D-dimer levels. FXIII A-subunit correlated with fibrinogen levels in patients with PE but not in patients without PE. FXIII A-subunit decreased with increasing pulmonary occlusion rate. The risk of PE was increased in the presence of A-subunit levels < 60% (OR 7.0 [95% CI 1.4-35.3], p=0.019). Clot firmness determined by TEG was lower in patients with PE than in patients without PE.In patients with PE, circulating FXIII A-subunit is decreased compared to patients with suspected but excluded PE. The higher the clot burden within the pulmonary arteries the lower the FXIII antigen. In these patients, direct relation of FXIII A-subunit to fibrinogen levels argues for significant consumption of these coagulation factors in PE. This consumption of FXIII can also be detected by a global coagulation test like TEG.

A safe strategy to rule out pulmonary embolism: The combination of the Wells score and D-dimer test: One prospective study

2017 ◽  
Vol 156 ◽  
pp. 160-162 ◽  
Author(s):  
Yuxia Ma ◽  
Yuliang Wang ◽  
Dengxiang Liu ◽  
Zhenyuan Ning ◽  
Min An ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prospective Study ◽  
Safe Strategy ◽  
Wells Score ◽  
D Dimer ◽  
Rule Out

Diagnostic strategy using a modified clinical decision rule and D-dimer test to rule out pulmonary embolism in elderly in- and outpatients

2005 ◽  
Vol 94 (07) ◽  
pp. 206-210 ◽  
Author(s):  
Pieter W. Kamphuisen ◽  
Patricia J. W. B. van Mierlo ◽  
Harry R. Büller ◽  
Maaike Söhne
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Challenge ◽  
Co Morbidity ◽  
D Dimer ◽  
Rule Out

SummaryExcluding or confirming pulmonary embolism remains a diagnostic challenge. In elderly patients pulmonary embolism is associated with substantial co-morbidity and mortality, and many elderly patients with suspected pulmonary embolism are inpatients. The safety and efficacy of the combination of a clinical probability (CDR) and d-dimer test in excluding pulmonary embolism in this group is unclear. We retrospectively analysed data of two prospective studies of consecutive in-and outpatients with suspected pulmonary embolism. The patients were categorized into three age groups: <65 years, 65–75 years and >75 years. The sensitivity, negative predictive value and the proportion of patients with the combination of a non-high CDR score according to Wells (≤ 4) and a normal d-dimer result were calculated for each group. In 747 consecutive patients with suspected pulmonary embolism, sensitivity and negative predictive value of a non-high CDR and a normal d-dimer result in outpatients (n=538) of all age categories (<65 years, 65–75 years and >75 years) were both 100%.These tests were, however, less reliable for inpatients(n=209), irrespective of their age (sensitivity 91% [ CI: 79–98%], negative predictive value 88 % [CI: 74–96%].The proportion of both in-and outpatients >75 years with a non-high CDR and a normal d-dimer concentration was only 14%,whereas this was 22% in patients 65–75 years and 41% among in-and outpatients <65 years, respectively. In elderly outpatients the combination of a non-high CDR and a normal d-dimer result is a safe strategy to rule out pulmonary embolism. However, in inpatients this algorithm is not reliable to safely exclude pulmonary embolism. In addition, the proportion of patients >65 years in which this strategy excludes pulmonary embolism is markedly lower compared to younger patients.

Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism

2006 ◽  
Vol 95 (04) ◽  
pp. 715-719 ◽  
Author(s):  
Grégoire Le Gal ◽  
Sylvain De Lucia ◽  
Pierre-Marie Roy ◽  
Guy Meyer ◽  
Drahomir Aujesky ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Diagnostic Value ◽  
Clinical Usefulness ◽  
Limited Data ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer ◽  
Rule Out

SummaryLimited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE).Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients witha malignancy. At cut-off values varying from 500 to 900 µg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI:11% to 24%) to 30% (95% CI:22% to 39%).The 3-month thromboembolic risk was 0% (95 % CI: 0% to 18%) in cancer patients witha negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test’s clinical usefulness.

The accuracy of D-dimer testing in suspected pulmonary embolism varies with the Wells score

2012 ◽  
Vol 10 (12) ◽  
pp. 2630-2632 ◽  
Author(s):  
J. van ES ◽  
L. F. M. BEENEN ◽  
V. E. A. GERDES ◽  
S. MIDDELDORP ◽  
R. A. DOUMA ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Suspected Pulmonary Embolism ◽  
Wells Score ◽  
D Dimer

D-Dimer and CT Rule Out Pulmonary Embolism

2008 ◽  
Vol 1 (2) ◽  
pp. 11
Author(s):  
DAMIAN MCNAMARA
Keyword(s):  
Pulmonary Embolism ◽  
D Dimer ◽  
Rule Out

A Comparative Analysis of D-Dimer Assays in Patients with Clinically Suspected Pulmonary Embolism

1993 ◽  
Vol 70 (03) ◽  
pp. 408-413 ◽  
Author(s):  
Edwin J R van Beek ◽  
Bram van den Ende ◽  
René J Berckmans ◽  
Yvonne T van der Heide ◽  
Dees P M Brandjes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Comparative Analysis ◽  
High Probability ◽  
Pulmonary Emboli ◽  
Plasma Samples ◽  
Suspected Pulmonary Embolism ◽  
Lung Scan ◽  
D Dimer

SummaryTo avoid angiography in patients with clinically suspected pulmonary embolism and non-diagnostic lung scan results, the use of D-dimer has been advocated. We assessed plasma samples of 151 consecutive patients with clinically suspected pulmonary embolism. Lung scan results were: normal (43), high probability (48) and non-diagnostic (60; angiography performed in 43; 12 pulmonary emboli). Reproducibility, cut-off values, specificity, and percentage of patients in whom angiography could be avoided (with sensitivity 100%) were determined for two latex and four ELISA assays.The latex methods (cut-off 500 μg/1) agreed with corresponding ELISA tests in 83% (15% normal latex, abnormal ELISA) and 81% (7% normal latex, abnormal ELISA). ELISA methods showed considerable within- (2–17%) and between-assay Variation (12–26%). Cut-off values were 25 μg/l (Behring), 50 μg/l (Agen), 300 μg/l (Stago) and 550 μg/l (Organon). Specificity was 14–38%; in 4–15% of patients angiography could be avoided.We conclude that latex D-dimer assays appear not useful, whereas ELISA methods may be of limited value in the exclusion of pulmonary embolism.

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