scholarly journals Use of SimpliRED D-dimer assay and computerised tomography in the diagnosis of acute pulmonary embolism

2009 ◽  
Vol 8 (2) ◽  
pp. 85-87
Author(s):  
Deepak Subedi ◽  
◽  
Derek Bell ◽  
Shazad Aslam ◽  
Marina J Brochwitz Lewinski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Predictive Values ◽  
Computed Tomographic ◽  
Unselected Patient ◽  
Risk Scoring ◽  
Sensitivity Specificity ◽  
D Dimer

Background: The utility of D-dimer in the diagnostic workup of pulmonary embolism has been established. Several D-dimer tests are available with different sensitivities and specificities. SimpliRED D-dimer is a rapid qualitative whole blood D-dimer assay suitable for bedside use. Objective: To assess the utility of the SimpliRED D-dimer test in patients with suspected acute pulmonary embolism in the absence of formal ‘risk scoring’. Design: A prospective study measuring SimpliRED D-dimer in unselected patients undergoing computed tomographic pulmonary angiography (CTPA) examination for suspected acute pulmonary embolism. Main outcome measures: D-dimer and CTPA results were compared. Sensitivity, specificity, and positive and negative predictive values of SimpliRED D-dimer were calculated for the unselected patient group. Results: Forty-seven patients underwent D-dimer testing and CTPA. SimpliRED D-dimer was positive in 23 and negative in 24 patients. D-dimer was positive in only 6 (50%) of the 12 patients with positive CTPA. Of the 35 with negative CTPA, 17 had positive D-dimer. The positive predictive value of the D-dimer was 26.1 % and the negative predictive value 75.0%. Conclusion: SimpliRED D-dimer should not be used in the diagnosis of pulmonary embolism in the absence of risk scoring.

scholarly journals Diagnostic performance of D-dimer in predicting pulmonary embolism in tuberculous pleural effusion patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoming Li ◽  
Yajing Qin ◽  
Wenjing Ye ◽  
Xi Chen ◽  
Dezhi Sun ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pleural Effusion ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Characteristic Curve ◽  
Pulmonary Angiography ◽  
Potential Mechanism ◽  
Tuberculous Pleural Effusion ◽  
Sensitivity Specificity ◽  
D Dimer

Abstract Background Tuberculous pleural effusion (TPE) patients usually have elevated D-dimer levels. The diagnostic performance of D-dimer in predicting pulmonary embolism (PE) in the TPE population is unclear. This study aimed to assess the diagnostic performance of D-dimer for PE in the TPE population and explore its potential mechanism. Methods We retrospectively analysed patients who were admitted to Xinhua Hospital and Weifang Respiratory Disease Hospital with confirmed TPE between March 2014 and January 2020. D-dimer levels were compared between patients with and without PE. To test the diagnostic performance of D-dimer in predicting PE, receiver operating characteristic curve analysis was performed. Positive predictive value (PPV) and negative predictive value (NPV) were also reported. To explore the potential mechanism of PE in TPE, inflammatory biomarkers were compared between PE and non-PE patients. Results This study included 248 patients (170 males and 78 females) aged 43 ± 20.6 years. Elevated D-dimer levels (≥ 0.5 mg/L) were detected in 186/248 (75%) patients. Of the 150 patients who underwent computed tomography pulmonary angiography, 29 were diagnosed with PE. Among the TPE population, the PE patients had significantly higher D-dimer levels than the non-PE patients (median, 1.06 mg/L vs. 0.84 mg/L, P < 0.05). The optimal cut-off value for D-dimer in predicting PE in TPE was 1.18 mg/L, with a sensitivity of 89.7% and a specificity of 77.8% (area under curve, 0.893; 95% confidence interval 0.839–0.947; P < 0.01). The PPV was 49.1%, while the NPV was 96.9% at a D-dimer cut-off of 1.18 mg/L for PE. PE patients had lower median WBC and interleukin (IL)-8 values (5.14 × 109/L vs. 6.1 × 109/L, P < 0.05; 30.2 pg/ml vs. 89.7 pg/ml, P < 0.05) but a higher median IL-2 receptor value (1964.8 pg/ml vs. 961.2 pg/ml, P < 0.01) than those in the non-PE patients. Conclusions D-dimer is an objective biomarker for predicting PE in patients with TPE. A D-dimer cut-off of 1.18 mg/L in the TPE population may reduce unnecessary radiological tests due to its excellent sensitivity, specificity, and NPV for PE. The imbalance of prothrombotic and antithrombotic cytokines may partly be attributed to the formation of pulmonary emboli in patients with TPE.

scholarly journals CT Pulmonary Angiography in Young Women

2017 ◽  
Vol 24 (3) ◽  
pp. 423-428 ◽  
Author(s):  
Paul D. Stein ◽  
Fadi Matta ◽  
Kate E. Hughes ◽  
Mary J. Hughes
Keyword(s):  
Pulmonary Embolism ◽  
Pregnant Women ◽  
Chest Radiograph ◽  
Young Women ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Computed Tomographic ◽  
Lung Scan ◽  
D Dimer

The purpose was to determine whether young women in the emergency department who received computed tomographic (CT) pulmonary angiograms were evaluated to receive lower dose imaging or no imaging, recognizing that the risks of radiation are particularly high in young women. This was a retrospective cohort investigation of women aged 18 to 29 years seen for suspected acute pulmonary embolism in emergency departments of 5 regional hospitals from May 1, 2015 to April 30, 2016. Computed tomographic (CT) pulmonary angiograms were obtained in 379 young women. Pulmonary embolism was diagnosed by CT angiography in 2.1%. A Wells probability score could be calculated in 11.9%. D-dimer was obtained in 46.2% and a chest radiograph was obtained in 41.7%. Among patients with a normal chest radiograph, 3.9% had a lung scan. Venous ultrasound of the lower extremities was obtained in 1.8%. Each had an elevated D-dimer. Among the young women who received CT angiograms, 53 were pregnant. In 17.0% of pregnant women, a Wells clinical probability score could be calculated from the medical record. D-dimer in pregnant women was obtained in 30.2%, chest radiograph in 22.6%, lung scan in 11.3%, and venous ultrasound of the lower extremities in none. In conclusion, young women and pregnant women often received CT pulmonary angiograms for suspected acute pulmonary embolism without an objective clinical assessment, measurement of D-dimer, lung scintiscan, or venous ultrasound, which may have eliminated the need for CT pulmonary angiography in many instances.

Combination of D-Dimer and Amino-Terminal Pro-B-Type Natriuretic Peptide Testing for the Evaluation of Dyspneic Patients With and Without Acute Pulmonary Embolism

2006 ◽  
Vol 130 (9) ◽  
pp. 1326-1329
Author(s):  
Stacy E. F. Melanson ◽  
Michael Laposata ◽  
Carlos A. Camargo, Jr ◽  
Annabel A. Chen ◽  
Roderick Tung ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Amino Terminal ◽  
Tomographic Angiography ◽  
D Dimer

Abstract Context.—D-dimer concentration can be used to exclude a diagnosis of acute pulmonary embolism. However, clinicians frequently order unnecessary supplemental testing in patients with low concentrations of D-dimer. Elevations in natriuretic peptides have also been described in the setting of pulmonary embolism. Objective.—We investigated the integrative role of D-dimer with amino-terminal pro-B-type natriuretic peptide for the evaluation of patients with and without acute pulmonary embolism. Design.—Patients were selected for analysis from a previous study in which levels of D-dimer and amino-terminal pro-B-type natriuretic peptide were measured. The presence of pulmonary embolism was determined by computed tomographic angiography. Results.—The median levels of D-dimer were significantly higher in patients with acute pulmonary embolism. Similarly, the median levels of amino-terminal pro-B-type natriuretic peptide were higher in patients with pulmonary embolism. Conclusions.—The Roche Tina-quant D-Dimer immunoturbidimetric assay provides a high negative predictive value and can be used to exclude acute pulmonary embolism in patients with dyspnea. Measurement of amino-terminal pro-B-type natriuretic peptide in addition to D-dimer improves specificity for acute pulmonary embolism without sacrificing negative predictive value. A combination of both markers may offer reassurance for excluding acute pulmonary embolism, and thus avoid redundant, expensive confirmatory tests.

scholarly journals Efficacy of D-Dimer Assay in Pulmonary Venous Thromboembolism: Study of 76 Cases

2021 ◽  
Author(s):  
Shubhi Saxena ◽  
Nishant Saxena ◽  
Richa Jain ◽  
Jasmin Jasani
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Wide Spectrum ◽  
Pulmonary Angiography ◽  
Retrospective Case ◽  
One Year ◽  
Sensitivity Specificity ◽  
D Dimer

Introduction: Venous Thromboembolism (VTE) encompasses a wide spectrum consisting predominantly of deep venous thrombosis and pulmonary embolism. The value of Fibrin Degradation Product (FDP) of which, most common is D-dimer which is most commonly deployed to pre-diagnose venous thrombosis. Diagnosing it has always been a hard effort. It is produced when cross-linked fibrin is broken down; among patient who is suspected of having pulmonary embolism, blood D-dimer levels correlate with the probability of having pulmonary embolism. Aim: This study was done to analyse the sensitivity of plasma D-dimer for VTE. Materials and Methods: Retrospective case study of 76 patients with VTE in form of pulmonary embolism done at the Dhiraj Hospital, Sumandeep Vidyapeeth Deemed University, Vadodara from January 2019 to January 2020 for a period of one year. Prethrombolytic plasma was withdrawn and D-dimer quantification were measured using fully automatic stago coagulometer instruement (STA Compact Max). Sensitivity, Specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) was calculated and formulated in tables and graphs. Results: The sensitivity, NPV, specificity and PPV of the D-dimer was 95.65%, 76.92%, 66.66% and 92.95%, respectively. CT pulmonary angiography had a specificity of 80%, sensitivity of 92.75%, a NPV of 70.58% and a PPV of 95.52%. Conclusion: D-dimer is mostly the go to test for ruling out VTE especially pulmonary embolism, if the pre-test probability is intermediate. Rationale use of this test does help in prognostification and helps to achieve therapeutics faster and more effectively.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

Evaluation of a Quantitative D-Dimer Latex Immunoassay for Acute Pulmonary Embolism Diagnosed by Computed Tomographic Angiography

2007 ◽  
Vol 82 (5) ◽  
pp. 556-560 ◽  
Author(s):  
David A. Froehling ◽  
Paul R. Daniels ◽  
Stephen J. Swensen ◽  
John A. Heit ◽  
Jayawant N. Mandrekar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
D Dimer
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