Infanta Elena Universitary Hospital, Spain.
Rey Juan Carlos Universitary Hospital, Spain.
Thromb Res. 2021 Jun;202:31-35. doi: 10.1016/j.thromres.2021.02.033. Epub 2021 Mar 6.
Abnormal D-dimer concentration measured during anticoagulation therapy (AT) or within one month of discontinuation, is associated with residual pulmonary obstruction (RPO) and risk of recurrent venous thromboembolism (VTE) after a first episode of pulmonary embolism (PE). We hypothesized that a significant decrease in D-dimer concentration within the first month of AT in patients with a first episode of PE may predict complete recanalization and a lower risk of recurrent VTE.
One hundred and fifty patients with PE received anticoagulation therapy for three or six months when control computed tomography angiography (CTA) was performed. D-dimer levels were measured at admission and at 1-, 3- and/or 6-month follow-ups after the initial event. Clinical, echocardiographic, CTA and analytical data were collected. Predictive factors of RPO and predictive ability of D-dimer concentration at 1- and 6-month follow-ups were evaluated.
Of the 150 eligible patients, 33 (22%) had RPO in control CTA. Idiopathic PE, a delay of >7 days between symptom onset and diagnosis, and clinical PE severity determined by a s-PESI score ≥ 1 were associated with RPO. D-dimer concentration within a month of AT was significantly higher (823 [558-1259] vs 436 [243-934] ng/ml; p = 0.019) in patients with RPO; decrease (445 [35-1899] vs 912 [476-2858] ng/ml; p = 0.047) and decrease percentage (31.4% vs 76.6%; p < 0.005) in D-dimer concentrations were significantly lower. ROC analysis showed that decrease percentage in D-dimer concentration identified patients with complete recanalization (AUC 0.715, [95% CI, 0.611-0.819], p < 0.005). Decreases of >70% in initial D-dimer at 1-month (OR, 0.56, [95% CI, 0.45-0.70] p = 0.037) and 6-month follow-ups (OR, 0.31 [CI 95%, 0.15-0.66], p = 0.03) were associated with a lower risk of recurrent PE.
A significant decrease in D-dimer concentration within the first month of AT is associated with complete recanalization and could predict a lower risk of recurrent thrombosis after a first episode of PE.
抗凝治疗（AT）期间或停药后一个月内测量的异常 D-二聚体浓度与首次肺栓塞（PE）后残余肺阻塞（RPO）和复发性静脉血栓栓塞（VTE）的风险相关。我们假设首次 PE 患者在 AT 的第一个月内 D-二聚体浓度显著下降可能预示着完全再通和复发性 VTE 的风险较低。
150 例 PE 患者接受 3 或 6 个月的抗凝治疗，同时进行对照 CT 血管造影（CTA）。在初始事件后 1、3 和/或 6 个月的随访时测量 D-二聚体水平。收集临床、超声心动图、CTA 和分析数据。评估 RPO 的预测因素和 1 个月和 6 个月随访时 D-二聚体浓度的预测能力。
在 150 名合格患者中，33 名（22%）在对照 CTA 中存在 RPO。特发性 PE、症状发作与诊断之间的延迟>7 天以及 s-PESI 评分≥1 确定的临床 PE 严重程度与 RPO 相关。在 RPO 患者中，AT 一个月内的 D-二聚体浓度明显较高（823[558-1259] vs 436[243-934]ng/ml；p=0.019）；D-二聚体浓度的下降（445[35-1899] vs 912[476-2858]ng/ml；p=0.047）和下降百分比（31.4% vs 76.6%；p<0.005）明显较低。ROC 分析显示，D-二聚体浓度下降百分比可识别完全再通的患者（AUC 0.715[95%CI，0.611-0.819]，p<0.005）。1 个月时（OR，0.56[95%CI，0.45-0.70]，p=0.037）和 6 个月时（OR，0.31[95%CI，0.15-0.66]，p=0.03）D-二聚体初始值下降>70%与复发性 PE 的风险降低相关。
AT 第一个月内 D-二聚体浓度的显著下降与完全再通相关，并可预测首次 PE 后复发性血栓形成的风险降低。
