title: Risk of recurrence in patients with pulmonary embolism: predictive role of D-dimer and of residual perfusion defects on lung scintigraphy.
abstract: The stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO.
authors.affiliation: Thrombosis Centre, Department of Heart and Vessels, AOU-Careggi, Florence, Italy. polida@aou-careggi.toscana.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.forename: Caterina
authors.initials: C
authors.lastname: Cenci
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.forename: Elisa
authors.initials: E
authors.lastname: Grifoni
authors.forename: Chiara
authors.initials: C
authors.lastname: Arcangeli
authors.forename: Domenico
authors.initials: D
authors.lastname: Prisco
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.forename: Massimo
authors.initials: M
authors.lastname: Miniati
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D015854:Up-Regulation; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D