Author(s):
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Tick, L.W.; Nijkeuter, M.;
Kramer, M.H.W.
; Hovens, M.M.; Buller, H.R.; Leebeek, F.W.; Huisman, M.V.; Halkes, C.J.; Heggelman, B.G.; Nix, M.; Sohne, M.; Bresser, P.J.;
Kool, D.R.
; Phoa, S.S.; Rekke, B.; Kaasjager, K.A.; Kwakkel-van Erp, J.M.; Grandjean, H.M.; Kesselring, F.O.H.W.; Mol, J.J.; Ullmann, E.F.; Guldener, C. van; Mijnsbergen, J.Y.; Sturm, M.F.; Swart, C. de; Kuijer, P.M.; Schrama, J.G.; Velde, A. van de; Huisman, P.M.; Eerden, M.M. van der; Janssen, P.J.; Jansen, R.; Lobatto, S.; Compier, E.A.; Eikenboom, H.C.; Roos, A. de; Belle, A. van; Prins, M.H.; Snoep, G.; Korte, H. de; Kos, C.B.; Laterveer, L.; Veldhuizen, W.C. van; Kamphuizen, P.W.;
Bredie, S.J.H.
;
Die, C.E. van
;
Heijdra, Y.F.
;
Lenders, J.W.M.
; Kruip, M.J.; Jie, K.S.; Kars, A.H.; Meiracker, A.H. van den; Pattynama, P.M.; Borst, J.M. de; Houten, A.A. van; Teng, H.T.
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Subject:
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IGMD 5: Health aging / healthy living N4i 1: Pathogenesis and modulation of inflammation NCEBP 14: Cardiovascular diseases UMCN 2.2: Vascular medicine and diabetes |
Organization:
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Nephrology Pathology Radiology Internal Medicine Pulmonary Diseases |
Journal title:
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Journal of Internal Medicine
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Abstract:
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Objective. To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods. D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL(-1) compared to levels between 500 and 1000 ng mL(-1). Patients with D-dimer levels higher than 2000 ng mL(-1) and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL(-1), the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion. Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied.
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