title: High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea.
abstract: Obstructive sleep apnoea is a risk factor for pulmonary embolism. Elevated D-dimer levels and other biomarkers are associated with recurrent pulmonary embolism. The objectives were to compare the frequency of elevated D-dimer levels (>500 ng·mL(-1)) and further coagulation biomarkers after oral anticoagulation withdrawal in pulmonary embolism patients, with and without obstructive sleep apnoea, including two control groups without pulmonary embolism.We performed home respiratory polygraphy. We also measured basic biochemical profile and haemogram, and coagulation biomarkers (D-dimer, prothrombin fragment 1+2, thrombin-antithrombin complex, plasminogen activator inhibitor 1, and soluble P-selectin).64 (74.4%) of the pulmonary embolism cases and 41 (46.11%) of the controls without pulmonary embolism had obstructive sleep apnoea. Plasmatic D-dimer was higher in PE patients with OSA than in those without obstructive sleep apnoea. D-dimer levels were significantly correlated with apnoea-hypopnoea index, and nocturnal hypoxia. There were more patients with high D-dimer after stopping anticoagulants in those with pulmonary embolism and obstructive sleep apnoea compared with PE without obstructive sleep apnoea (35.4% versus 19.0%, p=0.003). Apnoea-hypopnoea index was independently associated with high D-dimer.Pulmonary embolism patients with obstructive sleep apnoea had higher rates of elevated D-dimer levels after anticoagulation discontinuation for pulmonary embolism than in patients without obstructive sleep apnoea and, therefore, higher procoagulant state that might increase the risk of pulmonary embolism recurrence.
authors.affiliation: Dept of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: García Suquia
authors.affiliation: Dept of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain alberto.alonso@ssib.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Fernández
authors.affiliation: Dept of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: de la Peña
authors.affiliation: Dept of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Romero
authors.affiliation: IdISPa-FISIB, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Piérola
authors.affiliation: Dept of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Carrera
authors.affiliation: Dept of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Barceló
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: IdISPa-FISIB, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arque
authors.affiliation: Dept of Internal Medicine, University Hospital La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Dept of Internal Medicine, University Hospital La Paz, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain Dept of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: García-Río
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000990:Antithrombin III; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000378:metabolism*; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D019007:P-Selectin; D010446:Peptide Fragments; D017395:Plasminogen Activator Inhibitor 1; D011498:Protein Precursors; C546937:SELP protein, human; C051321:SERPINE1 protein, human; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases