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

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Dr Mariette Agterof, Dr James Chalmers and Dr Aran Singanayagam for contributing to this study by sending original unpublished data.

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Correspondence to Cecilia Becattini.

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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).

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  • D-Dimer
  • Pulmonary embolism
  • Prognosis