The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older：A prospective cohort study

Abstract Background: This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE.Methods: It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 hours including D-dimer level, platelet counts and fibrinogen level were collected for analyses.Results: 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 hours of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR=5.874, 95%CI: 2.678-12.886) and emergency cesarean section (OR=11.965, 95%CI: 2.732-52.401) were independently associated with VTE in puerperium of women age 35 or older.Conclusions: We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

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The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older: a prospective cohort study

Thrombosis Journal ◽

10.1186/s12959-020-00241-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Wen Hu ◽

Dong Xu ◽

Juan Li ◽

Cheng Chen ◽

Yuan Chen ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Predictive Value ◽

Fibrinogen Level ◽

Imaging Finding ◽

Statistical Correlation ◽

Roc Curve Analysis ◽

Platelet Counts ◽

Emergency Cesarean ◽

D Dimer

Abstract Background This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE. Methods It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12,451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 h including D-dimer level, platelet counts and fibrinogen level were collected for analyses. Results 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 h of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR = 5.874, 95%CI: 2.678–12.886) and emergency cesarean section (OR = 11.965, 95%CI: 2.732–52.401) were independently associated with VTE in puerperium of women age 35 or older. Conclusions We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

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The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older：A prospective cohort study

10.21203/rs.3.rs-45646/v2 ◽

2020 ◽

Author(s):

Wen Hu ◽

Dong Xu ◽

Juan Li ◽

Cheng Chen ◽

Yuan Chen ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Predictive Value ◽

Fibrinogen Level ◽

Imaging Finding ◽

Statistical Correlation ◽

Roc Curve Analysis ◽

Platelet Counts ◽

Emergency Cesarean ◽

D Dimer

Abstract Background: This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE. Methods: It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 hours including D-dimer level, platelet counts and fibrinogen level were collected for analyses. Results: 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 hours of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR=5.874, 95%CI: 2.678-12.886) and emergency cesarean section (OR=11.965, 95%CI: 2.732-52.401) were independently associated with VTE in puerperium of women age 35 or older.Conclusions: We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

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The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older: A prospective cohort study

10.21203/rs.3.rs-45646/v1 ◽

2020 ◽

Author(s):

Wen Hu ◽

Dong Xu ◽

Juan Li ◽

Cheng Chen ◽

Yuan Chen ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Predictive Value ◽

Imaging Finding ◽

Statistical Correlation ◽

Roc Curve Analysis ◽

School Of Medicine ◽

Emergency Cesarean ◽

Observational Cohort ◽

D Dimer

Abstract Background This study aimed to investigate the predictive value of the D-dimer for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE. Methods It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12451 women age 35 or older who delivered after 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 hours including D-dimer, platelet and fibrinogen were collected for analyses. Results 30(2.4‰) women were identified as VTE, including 1 PE event and 29 DVT events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 hours of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelets and VTE, as well as between fibrinogen and VTE. On multivariate analysis, D-dimer ≥ 5.50 mg/L (OR = 5.874, 95%CI: 2.678–12.886) and emergency cesarean section (OR = 11.965, 95%CI: 2.732–52.401) were independently associated with VTE in puerperium of women age 35 or older. Conclusions We concluded that D-dimer ≥ 5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.

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The Predictive Value of d-Dimer Test for Venous Thromboembolism During Puerperium: A Prospective Cohort Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620901786 ◽

2020 ◽

Vol 26 ◽

pp. 107602962090178

Author(s):

Wen Hu ◽

Yali Wang ◽

Juan Li ◽

Jian Huang ◽

Yuqun Pu ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Characteristic Curve ◽

Predictive Biomarkers ◽

Intrauterine Infection ◽

Statistical Correlation ◽

Emergency Cesarean ◽

Observational Cohort ◽

Scarred Uterus ◽

D Dimer

The aim of this study was to investigate the d-dimer for prediction of venous thromboembolism (VTE) events in puerperium and to identify other risk factors associated with the occurrence of VTE. This was a prospective observational cohort study, which included 16 127 women who gave birth after 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine, from January 2016 to December 2016. Data including basic maternal and fetal characteristics, pregnancy complications, and predictive biomarkers within postpartum 24 hours including d-dimer, platelet, and fibrinogen were collected for analyses. In the cohort study, 19 (0.12%) women were identified as VTE, including 1 pulmonary embolism event and 18 deep venous thrombosis events. The receiver operating characteristic curve analysis suggested the best cutoff point for d-dimer level within postpartum 24 hours was 3.695 mg/L, with a specificity of 75.5% and a sensitivity of 73.7%, and there was no statistical correlation between fibrinogen and VTE, as well as between platelets and VTE. On multivariate analysis, age ≥35 years (odds ratio [OR] = 2.895, 95% confidence interval [CI]: 1.079-7.773), scarred uterus (OR = 3.894, 95% CI: 1.234-12.282), intrauterine infection (OR = 7.214, 95% CI: 1.519-34.262), antiphospholipid syndrome (OR = 199.530, 95% CI: 15.152-2627.529), d-dimer ≥3.70 mg/L (OR = 7.573, 95% CI: 2.699-21.247), and emergency cesarean delivery (OR = 23.357, 95% CI: 2.819-193.508) were independently associated with VTE in puerperium. We concluded that d-dimer ≥3.70 mg/L was an independent predictor of VTE during puerperium and d-dimer testing was necessary for perinatal women.

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The negative predictive value of D-dimer on the risk of recurrent venous thromboembolism in patients with multiple previous events: A prospective cohort study (the PROLONG PLUS study)

American Journal of Hematology ◽

10.1002/ajh.23198 ◽

2012 ◽

Vol 87 (7) ◽

pp. 713-715 ◽

Cited By ~ 5

Author(s):

Walter Ageno ◽

Benilde Cosmi ◽

Angelo Ghirarduzzi ◽

Rita Santoro ◽

Eugenio Bucherini ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Negative Predictive Value ◽

Prospective Cohort Study ◽

Predictive Value ◽

Prospective Cohort ◽

Recurrent Venous Thromboembolism ◽

D Dimer

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Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70277-x ◽

2006 ◽

Vol 2006 ◽

pp. 361-362

Author(s):

G.L. Moneta

Keyword(s):

Venous Thromboembolism ◽

Predictive Value ◽

Recurrent Venous Thromboembolism ◽

D Dimer

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Update on the predictive value of D-dimer in patients with idiopathic venous thromboembolism

Thrombosis Research ◽

10.1016/s0049-3848(10)70016-5 ◽

2010 ◽

Vol 125 ◽

pp. S62-S65 ◽

Cited By ~ 17

Author(s):

Benilde Cosmi ◽

Gualtiero Palareti

Keyword(s):

Venous Thromboembolism ◽

Predictive Value ◽

D Dimer

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Risk of Venous Thromboembolism Recurrence: High Negative Predictive Value of D-dimer Performed after Oral Anticoagulation Is Stopped

Thrombosis and Haemostasis ◽

10.1055/s-0037-1612936 ◽

2002 ◽

Vol 87 (01) ◽

pp. 7-12 ◽

Cited By ~ 185

Author(s):

Cristina Legnani ◽

Benilde Cosmi ◽

Giuliana Guazzaloca ◽

Claudia Pancani ◽

Sergio Coccheri ◽

...

Keyword(s):

Venous Thromboembolism ◽

Negative Predictive Value ◽

Predictive Value ◽

Recurrent Events ◽

Oral Anticoagulant Therapy ◽

Lower Limbs ◽

First Episode ◽

Vein Thrombosis ◽

D Dimer

SummaryIn some patients with previous venous thromboembolism (VTE) D-dimer levels (D-Dimer) tend to increase after oral anticoagulant therapy (OAT) is stopped. The aim of our study was to evaluate the predictive value of D-Dimer for the risk of VTE recurrence after OAT withdrawal. After a first episode of deep vein thrombosis (DVT) of the lower limbs and/or pulmonary embolism (PE), 396 patients (median age 67 years, 198 males) were followed from the day of OAT discontinuation for 21 months. D-dimer was measured on the day of OAT withdrawal (T1), 3-4 weeks (T2) and 3 months (+/− 10 days, T3) thereafter. The main outcome events of the study were: objectively documented recurrent DVT and/or PE. D-dimer was found to be increased in 15.5%, 40.3% and 46.2% of the patients at T1, T2 and T3, respectively. In 199 (50.2%) patients, D-dimer levels were elevated in at least one measurement. During a follow-up of 628.4 years, 40 recurrences were recorded (10.1% of patients; 6.4% patient-years of follow-up). D-dimer was increased in at least one measurement in 28 of these cases, but remained normal in 11 subjects (three of whom had recurrent events triggered by circumstantial factors, three with malignancyassociated factors) (in one subject D-dimer was not measured). The negative predictive value (NPV) of D-dimer was 95.6% (95% CI 91.6-98.1) at T3 and was even higher (96.7%; 95% CI 92.9-98.8) after exclusion of the six recurrences due to circumstantial factors. Only five idiopathic recurrences occurred in the 186 patients with consistently normal D-dimer. In conclusion, D-dimer has a high NPV for VTE recurrence when performed after OAT discontinuation.

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Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery

Knee Surgery and Related Research ◽

10.1186/s43019-020-00068-x ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Ethan Toner ◽

Tobenna Oputa ◽

Heather Robinson ◽

Olivia McCabe-Robinson ◽

Andrew Sloan

Keyword(s):

Venous Thromboembolism ◽

Total Knee Replacement ◽

Positive Predictive Value ◽

Positive Result ◽

Knee Replacement ◽

Predictive Value ◽

Replacement Surgery ◽

Total Knee ◽

D Dimer ◽

Rule Out

Abstract Background Serum D-dimer is frequently used to rule out a diagnosis of venous thromboembolism (VTE), a recognised complication following total knee replacement (TKR). TKR is known to cause a rise in D-dimer levels, reducing its specificity. Previous studies have demonstrated that D-dimer remains elevated within 10 days of TKR and therefore should be avoided. The aim of this study was to determine whether serum D-dimer tests are clinically appropriate in identifying VTE when performed within 28 days of TKR. Methods Case notes for patients who had a serum D-dimer test performed for clinically suspected VTE at ≥ 28 days following TKR were retrospectively reviewed for a 6-year period. Demographics, D-dimer result, time after surgery and further radiological investigations were recorded. Results Fifty patients underwent D-dimer tests at ≥ 28 days following surgery (median 60 days, range 29–266); 48 of these patients had a positive result. Of these, five had confirmed VTE on radiological investigations. Serum D-dimer was raised in 96% of the patients. Only 10.42% of these patients had confirmed VTE. No patients with negative D-dimers had confirmed VTE. Conclusions These findings suggest that serum D-dimer remains raised for at least 28 days and possibly considerably longer following TKR. Serum D-dimer should not be used in patients with clinically suspected VTE within this period because of its unacceptably low specificity of 4.44% and positive predictive value of 10.42%, which can lead to a delay in necessary further radiological investigations, waste of resources and unnecessary exposure to harm.

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