A significant decrease in D-dimer concentration within one month of anticoagulation therapy as a predictor of both complete recanalization and risk of recurrence after initial pulmonary embolism.
Acute pulmonary embolism
D-dimer
Recurrent thrombosis
Residual pulmonary obstruction
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
30
11
2020
revised:
18
02
2021
accepted:
19
02
2021
pubmed:
13
3
2021
medline:
22
6
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Abnormal D-dimer concentration measured during anticoagulation therapy (AT) or within one month of discontinuation, is associated with residual pulmonary obstruction (RPO) and risk of recurrent venous thromboembolism (VTE) after a first episode of pulmonary embolism (PE). We hypothesized that a significant decrease in D-dimer concentration within the first month of AT in patients with a first episode of PE may predict complete recanalization and a lower risk of recurrent VTE. One hundred and fifty patients with PE received anticoagulation therapy for three or six months when control computed tomography angiography (CTA) was performed. D-dimer levels were measured at admission and at 1-, 3- and/or 6-month follow-ups after the initial event. Clinical, echocardiographic, CTA and analytical data were collected. Predictive factors of RPO and predictive ability of D-dimer concentration at 1- and 6-month follow-ups were evaluated. Of the 150 eligible patients, 33 (22%) had RPO in control CTA. Idiopathic PE, a delay of >7 days between symptom onset and diagnosis, and clinical PE severity determined by a s-PESI score ≥ 1 were associated with RPO. D-dimer concentration within a month of AT was significantly higher (823 [558-1259] vs 436 [243-934] ng/ml; p = 0.019) in patients with RPO; decrease (445 [35-1899] vs 912 [476-2858] ng/ml; p = 0.047) and decrease percentage (31.4% vs 76.6%; p < 0.005) in D-dimer concentrations were significantly lower. ROC analysis showed that decrease percentage in D-dimer concentration identified patients with complete recanalization (AUC 0.715, [95% CI, 0.611-0.819], p < 0.005). Decreases of >70% in initial D-dimer at 1-month (OR, 0.56, [95% CI, 0.45-0.70] p = 0.037) and 6-month follow-ups (OR, 0.31 [CI 95%, 0.15-0.66], p = 0.03) were associated with a lower risk of recurrent PE. A significant decrease in D-dimer concentration within the first month of AT is associated with complete recanalization and could predict a lower risk of recurrent thrombosis after a first episode of PE.
Sections du résumé
BACKGROUND
Abnormal D-dimer concentration measured during anticoagulation therapy (AT) or within one month of discontinuation, is associated with residual pulmonary obstruction (RPO) and risk of recurrent venous thromboembolism (VTE) after a first episode of pulmonary embolism (PE). We hypothesized that a significant decrease in D-dimer concentration within the first month of AT in patients with a first episode of PE may predict complete recanalization and a lower risk of recurrent VTE.
METHODS
One hundred and fifty patients with PE received anticoagulation therapy for three or six months when control computed tomography angiography (CTA) was performed. D-dimer levels were measured at admission and at 1-, 3- and/or 6-month follow-ups after the initial event. Clinical, echocardiographic, CTA and analytical data were collected. Predictive factors of RPO and predictive ability of D-dimer concentration at 1- and 6-month follow-ups were evaluated.
RESULTS
Of the 150 eligible patients, 33 (22%) had RPO in control CTA. Idiopathic PE, a delay of >7 days between symptom onset and diagnosis, and clinical PE severity determined by a s-PESI score ≥ 1 were associated with RPO. D-dimer concentration within a month of AT was significantly higher (823 [558-1259] vs 436 [243-934] ng/ml; p = 0.019) in patients with RPO; decrease (445 [35-1899] vs 912 [476-2858] ng/ml; p = 0.047) and decrease percentage (31.4% vs 76.6%; p < 0.005) in D-dimer concentrations were significantly lower. ROC analysis showed that decrease percentage in D-dimer concentration identified patients with complete recanalization (AUC 0.715, [95% CI, 0.611-0.819], p < 0.005). Decreases of >70% in initial D-dimer at 1-month (OR, 0.56, [95% CI, 0.45-0.70] p = 0.037) and 6-month follow-ups (OR, 0.31 [CI 95%, 0.15-0.66], p = 0.03) were associated with a lower risk of recurrent PE.
CONCLUSION
A significant decrease in D-dimer concentration within the first month of AT is associated with complete recanalization and could predict a lower risk of recurrent thrombosis after a first episode of PE.
Identifiants
pubmed: 33711756
pii: S0049-3848(21)00088-8
doi: 10.1016/j.thromres.2021.02.033
pii:
doi:
Substances chimiques
Anticoagulants
0
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
31-35Informations de copyright
Copyright © 2021 Elsevier Ltd. All rights reserved.