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Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound.
Thromb Haemost. 2001 Nov; 86(5):1156-60.TH

Abstract

Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30-50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 microg/L in patients with >50% perfusion defects compared to 2731 microg/L in those with <30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.

Authors+Show Affiliations

Division of Angiology and Hemostasis, Geneva University Hospital, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11816700

Citation

Galle, C, et al. "Prediction of Pulmonary Embolism Extent By Clinical Findings, D-dimer Level and Deep Vein Thrombosis Shown By Ultrasound." Thrombosis and Haemostasis, vol. 86, no. 5, 2001, pp. 1156-60.
Galle C, Papazyan JP, Miron MJ, et al. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost. 2001;86(5):1156-60.
Galle, C., Papazyan, J. P., Miron, M. J., Slosman, D., Bounameaux, H., & Perrier, A. (2001). Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thrombosis and Haemostasis, 86(5), 1156-60.
Galle C, et al. Prediction of Pulmonary Embolism Extent By Clinical Findings, D-dimer Level and Deep Vein Thrombosis Shown By Ultrasound. Thromb Haemost. 2001;86(5):1156-60. PubMed PMID: 11816700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. AU - Galle,C, AU - Papazyan,J P, AU - Miron,M J, AU - Slosman,D, AU - Bounameaux,H, AU - Perrier,A, PY - 2002/1/31/pubmed PY - 2003/4/5/medline PY - 2002/1/31/entrez SP - 1156 EP - 60 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 86 IS - 5 N2 - Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30-50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 microg/L in patients with >50% perfusion defects compared to 2731 microg/L in those with <30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/11816700/Prediction_of_pulmonary_embolism_extent_by_clinical_findings_D_dimer_level_and_deep_vein_thrombosis_shown_by_ultrasound_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=11816700.ui DB - PRIME DP - Unbound Medicine ER -