Document Detail


Elevated D-dimer concentration identifies patients with incomplete recanalization of pulmonary artery thromboemboli despite 6 months anticoagulation after the first episode of acute pulmonary embolism.
MedLine Citation:
PMID:  17931694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite long-term anticoagulation in some patients after acute pulmonary embolism (APE) pulmonary thrombi are not completely resolved. We hypothesized that elevated D-dimer concentration reflecting increased endogenous fibrinolysis may indicate incomplete pulmonary thrombi resolution after the first episode of PE. METHODS: 55 patients aged 54.7+/-18.6 years were anticoagulated for 6 months with acenocumarol (74.5% patients) or low molecular weight heparin (25.5% patients) when control spiral computed tomography (sCT), lung perfusion scintigraphy and D-dimer assessment were performed. RESULTS: Incomplete recanalization of pulmonary circulation was found in 39 (70.9%) patients - thrombi at sCT and/or > or =1 wedge-shaped perfusion defect at scintigraphy. Age, sex, rate of unprovoked APE, malignancies, thrombolysis in the acute phase and type of long-term anticoagulation were similar in patients without and with complete recanalization. D-dimer at follow-up but not on admission was higher in patients with then without incomplete recanalization (median 340 (80-2280) vs 160 (60-390) ng/mL, p=0.02). All 11 (20%) patients with D-dimer level >500 ng/mL at follow-up did not resolve thromboemboli completely. ROC analysis showed that D-dimer at follow-up identified patients with incomplete recanalization (AUC 0.709, 95% CI (0.560-0.831), p=0.007). Multivariable analysis confirmed that D-dimer >350 ng/mL at follow-up and right ventricle dysfunction at the diagnosis were independent predictors of incomplete recanalization (OR 18.58 (95% CI 1.97-175.19) and 7.03 (95% CI 1.43-34.6), respectively, p=0.0006). CONCLUSION: Elevated D-dimer after 6 months anticoagulation and right ventricular dysfunction at the diagnosis predict incomplete recanalization of pulmonary circulation after first episode of APE.
Authors:
Anna Kaczyńska; Maciej Kostrubiec; Ryszard Pacho; Jolanta Kunikowska; Piotr Pruszczyk
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-10-10
Journal Detail:
Title:  Thrombosis research     Volume:  122     ISSN:  0049-3848     ISO Abbreviation:  Thromb. Res.     Publication Date:  2008  
Date Detail:
Created Date:  2008-04-28     Completed Date:  2008-08-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  21-5     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
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MeSH Terms
Descriptor/Qualifier:
Acenocoumarol / therapeutic use
Adult
Aged
Anticoagulants / therapeutic use*
Area Under Curve
Biological Markers / blood
Female
Fibrin Fibrinogen Degradation Products / metabolism*
Follow-Up Studies
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Male
Middle Aged
Pulmonary Artery / surgery*
Pulmonary Embolism / drug therapy*,  radiography,  surgery*
Tomography, Spiral Computed
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/Heparin, Low-Molecular-Weight; 0/fibrin fragment D; 152-72-7/Acenocoumarol

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