In the case presented, I think that getting a
D-dimer test would be the next best step.
Do not order computed tomography pulmonary angiography when evaluating patients for suspected pulmonary embolism unless: (1) the patient has a
D-dimer concentration [greater than or equal to] 1000 ng/mL; or (2) the patient has a
D-dimer concentration [greater than or equal to] 500 ng/mL, PLUS: (A) clinical signs of deep vein thrombosis, (B) hemoptysis, or (C) you think pulmonary embolism is the most likely diagnosis.
Patients also underwent
D-dimer testing, and if they had clinical signs and symptoms of DVT, underwent compression utrasonography of the symptomatic leg.
D-dimer is one of the terminal fibrin decomposition products, which can affect cellular signaling systems, promote cell proliferation, stimulate cellular adhesion of tumor cells to endothelial cells and affect platelets and extra-cellular matrix, inducing the growth and spread of tumors.4
Infection and activation of the sepsis coagulation cascade are common and early events, and many of the molecules involved in this process, such as
D-dimer, are also important amplifiers of the inflammatory response.
(11) The result increased the number of patients in whom PE could be excluded using
d-dimer testing by approximately 50%, and further simplified the scoring system.
This may cause an increase in coagulation activation markers,
D-dimer (DD), and fibrin degradation products (FDPs), and a decrease in natural anticoagulant proteins (5-8).
22, 2018 (HealthDay News) -- A diagnostic strategy based on pretest clinical probability assessment, high-sensitivity
D-dimer testing, bilateral lower-limb compression ultrasonography (CUS), and computed tomography pulmonary angiography (CTPA) can safely rule out pulmonary embolism (PE) in pregnant women, according to a study published online Oct.
Objectives: To establish the relationship between the level of plasma
D-dimer concentration and systemic sclerosis.
NEW ORLEANS--Both the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio proved to be better predictors of the presence or absence of deep vein thrombosis than the ubiquitous
D-dimer test in a retrospective study, Jason Mouabbi, MD, reported at the annual meeting of the American College of Physicians.