title: Predictive value of D-dimer test for recurrent venous thromboembolism at hospital discharge in patients with acute pulmonary embolism.
abstract: D-dimer can be used to exclude acute pulmonary embolism (PE) for its high negative predictive value (NPV). Also, it is a predictor of recurrent venous thromboembolism (VTE) after anticoagulation withdrawal. The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE when tested at hospital discharge. Plasma D-dimer levels were repeatedly measured at hospital discharge in 204 consecutive patients with the first episode of acute pulmonary embolism. Patients were categorized to two groups by D-dimer levels at hospital discharge and followed up at 3, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE. D-dimer levels were persistently abnormal in 66 patients (32%). After 31±19 months follow-up, patients with persistently abnormal D-dimer level levels showed a higher rate of of recurrent VTE (14 patients, 21%) compared to those with D-dimer regression (8 patients, 6%) (P = 0.001). At the multivariate analysis, after adjustment for other relevant factors, persistently abnormal D-dimer level levels were an independent predictor of recurrent VTE in all subjects investigated, (hazard ratio, 4.10; 95% CI, 1.61-10.39; P = 0.003), especially in those with unprovoked PE (hazard ratio, 4.61; 95% CI, 1.85-11.49; P = 0.001). The negative predictive value of D-dimer was 94.2 and 92.9% in all subjects or those with unprovoked PE, respectively. Persistently abnormal D-dimer level levels at hospital discharge have a high negative predictive value for recurrence in patients with acute pulmonary embolism, especially in subjects with an unprovoked previous event.
authors.affiliation: Center for Pulmonary Vascular Disease Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, North Building, 167 Beilishi Road, Xicheng District, Beijing 100037, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Zhang
authors.forename: Qin
authors.initials: Q
authors.lastname: Luo
authors.forename: Zhi-Hui
authors.initials: ZH
authors.lastname: Zhao
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhao
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism; D012008:Recurrence; D054556:Venous Thromboembolism / Q000175:diagnosis*
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D