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D-Dimer for risk stratification in patients with acute pulmonary embolism

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Abstract

Background: Risk stratification is currently recommended for the initial management of patients with acute pulmonary embolism (PE). Methods: We performed a meta-analysis of studies in patients with acute PE to assess the prognostic value of elevated D-dimer levels for short-term (within 30 days) and 3-month mortality. The association between D-dimer levels and markers of PE severity was also reviewed. Unrestricted searches were performed using the terms D-dimer and pulmonary embolism. Studies reporting on D-dimer levels and mortality and/or markers of PE severity were included in the review. A random-effects model was used to pool study results, funnel-plot inspection to evaluate publication bias and I squared testing to test for heterogeneity. Results: Five studies (2,885 patients) reported on D-dimer levels and short-term mortality. D-dimer levels above a prognostic cut-off were significantly associated with short-term mortality in the overall population (OR: 2.76; 95% CI: 1.83–4.14; I2 = 0%) and in hemodynamically stable patients (three studies, 874 patients; OR: 4.28; 95% CI: 1.88–9.71; I2 = 0%). Four studies (1,254 patients) reported on D-dimer levels and 3-month mortality. D-dimer levels above a prognostic cut-off were associated with 3-month mortality (OR: 4.29; 95% IC: 1.70–10.79; I2 = 0%). Overall, 14 studies assessed the association between D-dimer and markers of PE severity. An association has been observed between D-dimer levels and the degree of pulmonary artery obstruction. Conclusion: In patients with acute PE elevated D-dimer is associated with increased short-term and 3-month mortality, suggesting the potential of using this test for both diagnosis and risk stratification.

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Acknowledgments

We acknowledge Dr Mariette Agterof, Dr James Chalmers and Dr Aran Singanayagam for contributing to this study by sending original unpublished data.

Author information

Correspondence to Cecilia Becattini.

Additional information

This study was performed without any external support.

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Becattini, C., Lignani, A., Masotti, L. et al. D-Dimer for risk stratification in patients with acute pulmonary embolism. J Thromb Thrombolysis 33, 48–57 (2012). https://doi.org/10.1007/s11239-011-0648-8

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Keywords

  • D-Dimer
  • Pulmonary embolism
  • Prognosis