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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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