D-dimer levels in VTE patients with distal and proximal clots

Adam J. Singer, Hui Zheng, Samuel Francis, Gregory J. Fermann, Anna Marie Chang, Blair A. Parry, Nick Giordano, Christopher Kabrhel

Research output: Contribution to journalArticle

Abstract

Objectives: There is growing evidence that venous thromboembolism (VTE) patients with distal clots (distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE]) may not routinely benefit from anticoagulation. We compared the D-dimer levels in VTE patients with distal and proximal clots. Methods: We conducted a multinational, prospective observational study of low-to-intermediate risk adult patients presenting to the emergency department (ED) with suspected VTE. Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate analyses. Results: Of 1752 patients with suspected DVT, 1561 (89.1%) had no DVT, 78 (4.4%) had a distal calf DVT, and 113 (6.4%) had a proximal DVT. DVT patients with proximal clots had higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL were 40.7% and 52.1% respectively. Of 1834 patients with suspected PE, 1726 (94.1%) had no PE, 7 (0.4%) had isolated sub-segmental PE, and 101 (5.5%) had non-sub-segmental PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL) than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer cutoff of 3499 mg/dL were 57.4% and 10.4% respectively. Conclusions: VTE patients with proximal clots had higher D-dimer levels than patients with distal clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients with distal or proximal clots.

Original languageEnglish (US)
Pages (from-to)33-37
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Venous Thromboembolism
Pulmonary Embolism
Venous Thrombosis
fibrin fragment D
Observational Studies
Hospital Emergency Service
Multivariate Analysis
Prospective Studies

Keywords

  • D-dimer
  • Distal DVT
  • DVT
  • Pulmonary embolism
  • Sub-segmental PE

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Singer, A. J., Zheng, H., Francis, S., Fermann, G. J., Chang, A. M., Parry, B. A., ... Kabrhel, C. (2019). D-dimer levels in VTE patients with distal and proximal clots. American Journal of Emergency Medicine, 37(1), 33-37. https://doi.org/10.1016/j.ajem.2018.04.040

D-dimer levels in VTE patients with distal and proximal clots. / Singer, Adam J.; Zheng, Hui; Francis, Samuel; Fermann, Gregory J.; Chang, Anna Marie; Parry, Blair A.; Giordano, Nick; Kabrhel, Christopher.

In: American Journal of Emergency Medicine, Vol. 37, No. 1, 01.01.2019, p. 33-37.

Research output: Contribution to journalArticle

Singer, AJ, Zheng, H, Francis, S, Fermann, GJ, Chang, AM, Parry, BA, Giordano, N & Kabrhel, C 2019, 'D-dimer levels in VTE patients with distal and proximal clots', American Journal of Emergency Medicine, vol. 37, no. 1, pp. 33-37. https://doi.org/10.1016/j.ajem.2018.04.040
Singer AJ, Zheng H, Francis S, Fermann GJ, Chang AM, Parry BA et al. D-dimer levels in VTE patients with distal and proximal clots. American Journal of Emergency Medicine. 2019 Jan 1;37(1):33-37. https://doi.org/10.1016/j.ajem.2018.04.040
Singer, Adam J. ; Zheng, Hui ; Francis, Samuel ; Fermann, Gregory J. ; Chang, Anna Marie ; Parry, Blair A. ; Giordano, Nick ; Kabrhel, Christopher. / D-dimer levels in VTE patients with distal and proximal clots. In: American Journal of Emergency Medicine. 2019 ; Vol. 37, No. 1. pp. 33-37.
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abstract = "Objectives: There is growing evidence that venous thromboembolism (VTE) patients with distal clots (distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE]) may not routinely benefit from anticoagulation. We compared the D-dimer levels in VTE patients with distal and proximal clots. Methods: We conducted a multinational, prospective observational study of low-to-intermediate risk adult patients presenting to the emergency department (ED) with suspected VTE. Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate analyses. Results: Of 1752 patients with suspected DVT, 1561 (89.1{\%}) had no DVT, 78 (4.4{\%}) had a distal calf DVT, and 113 (6.4{\%}) had a proximal DVT. DVT patients with proximal clots had higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL were 40.7{\%} and 52.1{\%} respectively. Of 1834 patients with suspected PE, 1726 (94.1{\%}) had no PE, 7 (0.4{\%}) had isolated sub-segmental PE, and 101 (5.5{\%}) had non-sub-segmental PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL) than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer cutoff of 3499 mg/dL were 57.4{\%} and 10.4{\%} respectively. Conclusions: VTE patients with proximal clots had higher D-dimer levels than patients with distal clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients with distal or proximal clots.",
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AU - Zheng, Hui

AU - Francis, Samuel

AU - Fermann, Gregory J.

AU - Chang, Anna Marie

AU - Parry, Blair A.

AU - Giordano, Nick

AU - Kabrhel, Christopher

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N2 - Objectives: There is growing evidence that venous thromboembolism (VTE) patients with distal clots (distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE]) may not routinely benefit from anticoagulation. We compared the D-dimer levels in VTE patients with distal and proximal clots. Methods: We conducted a multinational, prospective observational study of low-to-intermediate risk adult patients presenting to the emergency department (ED) with suspected VTE. Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate analyses. Results: Of 1752 patients with suspected DVT, 1561 (89.1%) had no DVT, 78 (4.4%) had a distal calf DVT, and 113 (6.4%) had a proximal DVT. DVT patients with proximal clots had higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL were 40.7% and 52.1% respectively. Of 1834 patients with suspected PE, 1726 (94.1%) had no PE, 7 (0.4%) had isolated sub-segmental PE, and 101 (5.5%) had non-sub-segmental PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL) than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer cutoff of 3499 mg/dL were 57.4% and 10.4% respectively. Conclusions: VTE patients with proximal clots had higher D-dimer levels than patients with distal clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients with distal or proximal clots.

AB - Objectives: There is growing evidence that venous thromboembolism (VTE) patients with distal clots (distal calf deep vein thrombosis [DVT] and sub-segmental pulmonary embolism [PE]) may not routinely benefit from anticoagulation. We compared the D-dimer levels in VTE patients with distal and proximal clots. Methods: We conducted a multinational, prospective observational study of low-to-intermediate risk adult patients presenting to the emergency department (ED) with suspected VTE. Patients were classified as distal (calf DVT or sub-segmental PE) or proximal (proximal DVT or non-sub-segmental PE) clot groups and compared with univariate and multivariate analyses. Results: Of 1752 patients with suspected DVT, 1561 (89.1%) had no DVT, 78 (4.4%) had a distal calf DVT, and 113 (6.4%) had a proximal DVT. DVT patients with proximal clots had higher D-dimer levels (3760 vs. 1670 mg/dL) than with distal clots. Sensitivity and negative predictive value (NPV) for proximal DVT at an optimal D-dimer cutoff of 5770 mg/dL were 40.7% and 52.1% respectively. Of 1834 patients with suspected PE, 1726 (94.1%) had no PE, 7 (0.4%) had isolated sub-segmental PE, and 101 (5.5%) had non-sub-segmental PE. PE patients with proximal clots had higher D-dimer levels (4170 vs. 2520 mg/dL) than those with distal clots. Sensitivity and NPV for proximal PE at an optimal D-dimer cutoff of 3499 mg/dL were 57.4% and 10.4% respectively. Conclusions: VTE patients with proximal clots had higher D-dimer levels than patients with distal clots. However, D-dimer levels cannot be used alone to discriminate between VTE patients with distal or proximal clots.

KW - D-dimer

KW - Distal DVT

KW - DVT

KW - Pulmonary embolism

KW - Sub-segmental PE

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