Use of D-dimer for the exclusion of new pulmonary embolism in anticoagulated patients: A multicenter retrospective study

E. Beaudoin¹, S. Kaka², E. Gagnon¹, A. Durivage¹, i. boulais¹, G. Le Templier¹, D. Toupin¹, G. Le Gal³, B. Gouin¹

¹Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke, Sherbrooke, Quebec, Canada, ²University of Ottawa, Ottawa, Canada, Ottawa, Ontario, Canada, ³Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada, Ottawa, Ontario, Canada

Abstract Number: VPB0979

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » VTE Diagnosis

Background: The use of plasma D-dimer level to exclude pulmonary embolism (PE) in low-intermediate risk non-anticoagulated patients has been well studied. However, its use for patients on chronic direct-acting oral anticoagulant (DOAC) therapy is unclear.

Aims: We aimed to evaluate D-dimer performance for the exclusion of PE among patients on DOACs who presented to the emergency department (ED) and underwent lung imaging for clinically suspected PE.

Methods: Patients aged ≥ 18 years on DOAC therapy who presented to the ED between January 2010 and June 2019 and had, in one visit (or in two visits within two days), a plasma D-dimer measurement and an imaging test to assess PE (CT pulmonary angiography or ventilation-perfusion scintigraphy) were included. The primary outcome was to evaluate the diagnostic accuracy of a negative D-dimer in the exclusion of a new PE.

Results: Our study included 109 patients. Only four patients (3.7%) had a new diagnosis of PE, of which two had active cancer. The sensitivity of abnormal conventional or age adjusted D-dimer thresholds to detect PE in this population was 100.0% (95%CI 39.8-100.0) for both thresholds, whilst the negative predictive value to exclude PE in this population was 100.0% (95%CI 91.8-100.0 and 93.8-100.0 respectively for each D-dimer threshold).

Conclusion(s): In patients on chronic DOAC therapy, plasma D-dimer level appears to have a high sensitivity and a high negative predictive value. This study suggests a possible role of plasma D-dimer level in the exclusion of PE among patients on DOAC therapy with a clinical suspicion of PE. However, these findings are hypothesis-generating only, and further studies are required.

Table

Table 1 : Personal characteristics, paraclinical tests and treatments of patients

Table

Table 2: Performance of conventional and age-adjusted D-Dimer in the prediction of pulmonary embolism. A. In the study population. B. According to patients’ oncologic status

To cite this abstract in AMA style:

Beaudoin E, Kaka S, Gagnon E, Durivage A, boulais i, Le Templier G, Toupin D, Le Gal G, Gouin B. Use of D-dimer for the exclusion of new pulmonary embolism in anticoagulated patients: A multicenter retrospective study [abstract]. https://abstracts.isth.org/abstract/use-of-d-dimer-for-the-exclusion-of-new-pulmonary-embolism-in-anticoagulated-patients-a-multicenter-retrospective-study/. Accessed August 16, 2022.

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