• anticoagulants
• heart ventricles
• hemodynamics
• management
• mechanisms
• pulmonary embolism
• right ventricular dysfunction

• Compression ultrasound
• Thrombosis
• diagnostic criteria
• differential diagnosis
• pitfalls

• Humans
• Ultrasonography
• Thrombosis/diagnostic imaging

• D-dimer
• Revision total knee arthroplasty
• TXA
• Tranexamic acid
• rTKA

Venous thromboembolism (VTE) is a major cause of morbidity and mortality among hospitalized patients. Studies have reported an incidence of deep venous thrombosis to be as high as 50%, especially after craniotomy. Several factors are involved in the alteration of the specificity and sensitivity of D-dimer testing. These include symptom duration, the extent of fibrinolytic and thrombosis activity, anticoagulant therapy, comorbidity associated with medical or surgical illness, cancer, inflammatory diseases, old age, postpartum, and pregnancy period, as well as previous VTE. Several studies have shown the high sensitivity of the D-dimer test (>95%) in pulmonary embolism or acute deep venous thrombosis. The cut-off value is usually within the 500 µg FEU/L range, ruling out acute VTE, especially in patients with low or intermediate clinical probability. Patients who present with a high D-dimer level may necessitate an intense diagnostic approach, the pretest probability notwithstanding. Herein, we present a case of a 52-year-old male patient who presented with a normal D-dimer level in deep venous thrombosis.

• Caprini score
• D-dimer
• Deep vein thrombosis
• Fracture
• High-energy injuries

• Adult
• Biomarkers/blood
• Cross-Sectional Studies
• Female
• Fibrin Fibrinogen Degradation Products/metabolism
• Humans
• Lumbar Vertebrae/injuries
• Lumbar Vertebrae/surgery
• Male
• Middle Aged
• Preoperative Care/methods
• Preoperative Care/standards
• Retrospective Studies
• Risk Assessment/standards
• Spinal Fractures/blood
• Spinal Fractures/diagnosis
• Spinal Fractures/surgery
• Thoracic Vertebrae/injuries
• Thoracic Vertebrae/surgery
• Venous Thrombosis/blood
• Venous Thrombosis/diagnosis
• Venous Thrombosis/surgery

This study was performed to determine the association of D-dimers measured at the time of admission with the development of acute kidney injury (AKI) in pregnant women.

We retrospectively analyzed the data of 625 women who developed AKI and 628 normal pregnant women admitted to our hospital from January 2014 to December 2018. The primary endpoint of the study was the development of AKI in pregnant women, and the secondary endpoint was the development of dialysis and death in women with AKI. Univariate and multivariate analyses were conducted.

The D-dimer concentration was significantly higher in patients with than without pregnancy-related AKI (PR-AKI). Multivariate logistic regression showed that a D-dimer concentration of >1108 ng/mL was an independent predictor of PR-AKI. The area under the curve of the D-dimer concentration as a prognostic indicator of PR-AKI was 0.652 (95% confidence interval, 0.622–0.683), that for patients with PR-AKI undergoing dialysis was 0.819 (95% confidence interval, 0.709–0.928), and that for patients who died was 0.828 (95% confidence interval, 0.670–0.986).

The D-dimer concentration is significantly associated with the development of AKI in pregnant patients and may increase the risk of dialysis and death in women with AKI.

• D-dimer
• dialysis
• intensive care unit
• mortality
• predictive factor
• pregnancy-related acute kidney injury

• D-dimer
• ageage adjusted
• cut-off level
• elderly patients

• Aged
• Cost-Benefit Analysis
• Fibrin Fibrinogen Degradation Products
• Humans
• Middle Aged
• Probability
• Pulmonary Embolism/diagnosis
• Retrospective Studies
• Venous Thromboembolism/diagnosis

Background: Isolated distal deep vein thrombosis (IDDVT) accounts for ~50% of all patients diagnosed with deep venous thrombosis (DVT), but the diagnosis and optimal management of IDDVT remains unclear and controversial. The aim of this study was to explore potential risk factors and predictors of IDDVT, and to evaluate different strategies of anticoagulation therapy.

Methods: A total of 310 consecutive patients after thoracic surgery, who underwent whole-leg ultrasonography as well as routine measurements of D-dimer levels before and after surgery were evaluated. The general clinical data, anticoagulant therapy, pre- and postoperative D-dimer levels were collected. Differences between IDDVT, DVT and non-DVT groups were calculated. Logistic regression analysis was used to analyze risk factors of postoperative IDDVT.

Results: Age and postoperative D-dimer levels were significantly higher in IDDVT group than in non DVT group (p = 0.0053 and p < 0.001, respectively). Logistic regression analysis showed that postoperative D-dimer level was a significant independent predictor of IDDVT even when adjusted for age and operation method (p = 0.0003). There were no significant side effects associated with both full-dose and half-dose anticoagulation regimens. Half-dose therapy was associated with a significant decrease in the requirement for anticoagulation medications after discharge (p = 0.0002).

Conclusion: Age and D-dimer levels after surgery are strong predictors of IDDVT following thoracic surgery. Half-dose therapeutic anticoagulation has the same efficiency in preventing IDDVT progression, is not associated with any additional risks of adverse effects compared to a full-dose regimen, and may be adopted for treating IDDVT patients after thoracic surgery.

• D-dimer
• IDDVT
• anticoagulation therapy
• risk factors
• thoracic surgery

• VTE diagnosis
• pregnancy and VTE
• review VTE

胸部恶性肿瘤患者围术期发生静脉血栓栓塞症（venous thromboembolism, VTE）风险较高，VTE的发生将影响患者的预后、远期生活质量，严重者甚至致死。为了加强胸外科医生对胸部恶性肿瘤患者围术期VTE的了解和重视，中国胸外科静脉血栓栓塞症研究协作组发布了《胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识（2018版）》。本文针对共识中D-二聚体在VTE中的诊断价值及风险预测价值进行详细解读，并对其他生物标记物在肿瘤患者VTE的作用做简要拓展，以加深胸外科医生对D-二聚体在VTE中临床意义的理解。

• Clinical significance
• D-dimer
• Thoracic cancer
• Venous thromboembolism

• clinical outcomes
• d-dimer
• long-term prognosis
• st-segment elevation myocardial infarction

• Aged
• Angiography
• China/epidemiology
• Female
• Fibrin Fibrinogen Degradation Products/metabolism
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• ST Elevation Myocardial Infarction/blood
• ST Elevation Myocardial Infarction/diagnostic imaging

• D-dimers
• eye
• fibrin
• fibrinolysis
• rabbit
• uveitis

• D-dimer
• anti-Xa factor activity
• deep vein thrombosis
• postoperative complications
• pulmonary thromboembolism

• Deep vein thrombosis
• Postoperative complications
• Pulmonary embolism
• Venous thromboembolism

• Adult
• Aged
• Diagnostic Imaging/trends
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Postoperative Complications/diagnostic imaging
• Postoperative Complications/epidemiology
• Prognosis
• Pulmonary Embolism/diagnostic imaging
• Pulmonary Embolism/epidemiology
• Retrospective Studies
• Venous Thromboembolism/diagnostic imaging

Although the incidence of venous thromboembolism (VTE) in Asian populations is lower than in Western countries, the overall burden of VTE in Asia has been considerably underestimated. Factors that may explain the lower prevalence of VTE in Asian populations relative to Western populations include the limited availability of epidemiological data in Asia, ethnic differences in the genetic predisposition to VTE, underdiagnoses, low awareness toward thrombotic disease, and possibly less symptomatic VTE in Asian patients. The clinical assessment, diagnostic testing, and therapeutic considerations for VTE are, in general, the same in Asian populations as they are in Western populations. The management of VTE is based upon balancing the treatment benefits against the risk of bleeding. This is an especially important consideration for Asian populations because of increased risk of intracranial hemorrhage with vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants have shown advantages over current treatment modalities with respect to bleeding outcomes in major phase 3 clinical trials, including in Asian populations. Although anticoagulant therapy has been shown to reduce the risk of postoperative VTE in Western populations, VTE prophylaxis is not administered routinely in Asian countries. Despite advances in the management of VTE, data in Asian populations on the incidence, prevalence, recurrence, risk factors, and management of bleeding complications are limited and there is need for increased awareness. To that end, this review summarizes the available data on the epidemiology, risk stratification, diagnosis, and treatment considerations in the management of VTE in Asia.

• Asia
• Epidemiology
• Risk factors
• Treatment
• Venous thromboembolism

• D-dimer
• Japanese patients
• deep vein thrombosis
• medical patients
• predictors

The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being “auto-anticoagulated”, prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin (PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in prevention and treatment strategies. Other bleeding sites that are frequently part of end-stage liver disease are similar to clinical manifestations of thrombocytopenia, with gum bleeding and epistaxis being very common but fortunately only rarely a cause of life-threatening bleeding. On the contrary, manifestations of coagulation factor deficiencies like soft tissue bleeding and hemartrosis are rare in patients with cirrhosis. As far as thrombotic complications are concerned, portal vein thrombosis is the most common event in patients with cirrhosis, but venous thromboembolism is not infrequent, and results in important morbidity and mortality in patients with cirrhosis, especially those with decompensated disease. Future studies and the more widespread use of point-of-care tests in evaluating hemostasis will aid the clinician in decision making when facing the patient with bleeding or with thrombotic complications, with both ends of a continuum being potentially fatal.

• Bleeding
• Hemorrhage
• Thromboembolism
• Portal vein thrombosis
• Coagulation
• Cirrhosis

• D-dimer
• Diagnosis
• Superficial vein thrombosis
• Ultrasonography
• Ultrasound imaging
• Upper extremity deep vein thrombosis

• Antifibrinolytic Agents/administration & dosage
• Antifibrinolytic Agents/therapeutic use
• Female
• Fibrin Fibrinogen Degradation Products/administration & dosage
• Fibrin Fibrinogen Degradation Products/therapeutic use
• Humans
• Male
• Prospective Studies
• Ultrasonography
• Upper Extremity Deep Vein Thrombosis/diagnostic imaging
• Upper Extremity Deep Vein Thrombosis/drug therapy

Venous thromboembolism (VTE) is the leading cause of morbidity and mortality among hospitalized patients. We searched the PubMed database and reviewed the articles published until June 2011. Articles related to the D-dimer and VTE were considered to write this paper. Many factors play a key role in changing the sensitivity and specificity of D-dimer testing, including the extent of thrombosis and fibrinolytic activity, duration of symptoms, anticoagulant therapy, comorbidity due to surgical or medical illnesses, inflammatory diseases, cancer, elderly age, pregnancy and the postpartum period, and previous VTE. Many previous studies have shown that the D-dimer test is highly sensitive (>95%) in acute deep venous thrombosis or pulmonary embolism, usually with a cut-off value of 500 μg FEU/l, which reasonably rules out acute VTE, particularly in patients with low clinical probability (LCP) or intermediate clinical probability. Patients with high D-dimer levels upon presentation may prompt a more intense diagnostic approach, irrespective of pretest probability. Studies performed after a negative D-dimer for 3 months proved the high negative predictive value (NPV) of D-dimer testing together with LCP in patients with suspected VTE. Among oncology patients, D-dimer testing has the highest sensitivity and NPV in excluding VTE. The new cutoff values of D-dimer testing were analyzed in a recent prospective study of pregnant women; they are 286 ng DDU/ml, 457 ng DDU/ml, and 644 ng DDU/ml for the first, second, and third trimesters, respectively.

• Clinical probability rule
• D-dimer
• Venous thromboembolism

Venous thromboembolism (VTE) requires urgent diagnosis and treatment to avoid related complications. Clinical presentations of VTE are nonspecific and require definitive confirmation by imaging techniques. A clinical pretest probability (PTP) score system helps predict VTE and reduces the need for costly imaging studies. d-dimer (DD) assay has been used to screen patients for VTE and has shown to be specific for VTE. The combined use of PTP and DD assay may improve exclusion of VTE and safely avoid imaging studies.

We prospectively used the Wells PTP score and a DD test to evaluate 230 consecutive patients who presented with VTE symptoms. The receiver operating characteristic curve was used to identify a new DD cutoff value, which was applied to VTE diagnosis and compared with the upper limit of locally established reference range for prediction of thrombosis alone and in combination with the clinical PTP score.

We evaluated 118 patients with VTE symptoms fulfilling the inclusion criteria, 64 (54.2%) with clinically suspected deep vein thrombosis (DVT) and 54 (45.8%) with symptoms of pulmonary embolism (PE). The PTP was low in 28 (43.8%) and moderate/high in 36 (56.25%) of the suspected DVT patients, and low in 29 (53.7%) and moderate/high in 25 (46.3%) of the suspected PE patients. Eighteen cases were confirmed by imaging studies: 9 DVT and 9 PE. The agreement between confirmed cases and PTP was significant with PE but not DVT. The negative predictive value for both DVT and PE with current DD cutoff value of <250 μg/L DDU was 100%, whereas with the calculated cutoff the NPV was 88%.

We confirm that PTP score is valuable tool for medical residents to improve the detection accuracy of VTE, especially for PE. The DD cutoff value of 250 μg/L FEU is ideal for excluding most cases of low PTP; however, the calculated cutoff was less specific for the exclusion of VTE.

• Clinical probability
• Deep vein thrombosis
• Pulmonary embolism
• d-dimer

Cerebral infarction is usually associated with arteriosclerosis, vascular endothelial cell injury and blood flow through the vascular system. The diagnostic value of markers, including von Willebrand factor antigen (vWF:Ag), D-dimer (D-D) and fibrinogen/fibrin degradation product (FDP), have not been studied in patients with acute cerebral infarction. Thus, the aim of the present study was to use receiver operating characteristic (ROC) curves to evaluate the diagnostic significance of vWF:Ag, D-D and FDP in 94 cases of acute cerebral infarction. The results revealed that vWF:Ag and D-D concentrations were significantly higher in acute cerebral infarction patients as compared with the normal controls (P<0.01), whereas no statistically significant difference in FDP was observed between the groups (P>0.01). Plasma vWF:Ag and D-D concentrations significantly correlated with the National Institute of Health Stroke Scale (NIHSS) scores (r=0.625 and 0.582, respectively; P<0.01). In addition, the vWF:Ag concentration significantly correlated with the D-D concentration (r=0.320; P<0.01), whereas FDP concentration did not correlate with D-D or vWF:Ag concentrations or the NIHSS scores (r=0.172, 0.188 and 0.065, respectively; P>0.05). The area under the ROC curve using vWF:Ag as a diagnostic marker in patients with acute cerebral infarction was 0.900, while for D-D the area was 0.795 and for FDP the area was 0.465. Logistic regression analysis revealed that the odds ratios of vWF:Ag and D-D were 16.727 and 2.324, respectively, which were statistically significant (P<0.001 and 0.023, respectively). These results indicated that using vWF:Ag as a diagnostic marker is likely to significantly improve the sensitivity of diagnosing patients with acute cerebral infarction. The diagnostic value of vWF:Ag concentration was significantly higher compared with D-D and FDP levels.

• D-dimer
• acute cerebral infarction
• fibrinogen degradation product
• receiver operating characteristic curve
• von Willebrand factor antigen

• D-dimer testing
• Emergency department
• Thrombosis
• Venous thromboembolism

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Bacterial Infections/blood
• Cohort Studies
• Emergency Service, Hospital
• Female
• Fibrin Fibrinogen Degradation Products/metabolism
• Heart Failure/blood
• Humans
• Male
• Middle Aged
• Neoplasms/blood
• Odds Ratio
• Pneumonia/blood
• Pulmonary Embolism/blood
• Pulmonary Embolism/diagnosis
• Retrospective Studies
• Sensitivity and Specificity
• Syncope/blood
• Urban Population
• Venous Thromboembolism/blood
• Venous Thromboembolism/diagnosis
• Venous Thrombosis/blood
• Venous Thrombosis/diagnosis
• Wounds and Injuries/blood

• Chronic obstructive pulmonary disease (COPD)
• D-dimer
• pulmonary embolism (PE)

• Acute Disease
• Algorithms
• Biomarkers/blood
• Decision Support Techniques
• Fibrin Fibrinogen Degradation Products/analysis
• Humans
• Magnetic Resonance Angiography
• Phlebography/methods
• Predictive Value of Tests
• Prognosis
• Pulmonary Embolism/blood
• Pulmonary Embolism/diagnosis
• Pulmonary Embolism/therapy
• Recurrence
• Risk Assessment
• Risk Factors
• Tomography, X-Ray Computed
• Ultrasonography/methods
• Venous Thromboembolism/blood
• Venous Thromboembolism/diagnosis
• Venous Thromboembolism/therapy
• Venous Thrombosis/blood
• Venous Thrombosis/diagnosis
• Venous Thrombosis/therapy

• D-dimer
• Wells score
• calf thrombosis
• compression ultrasonography
• deep vein thrombosis
• diagnosis
• sensitivity
• specificity

• Aged
• Algorithms
• Cross-Sectional Studies
• Female
• Fibrin Fibrinogen Degradation Products/analysis
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prevalence
• ROC Curve
• Reproducibility of Results
• Sensitivity and Specificity
• Thrombosis/pathology
• Ultrasonography
• Venous Thrombosis/blood
• Venous Thrombosis/diagnosis
• Venous Thrombosis/diagnostic imaging

Limited understanding of the presentation and course of influenza A(H5N1) infection in humans hinders evidence-based management.

We reviewed the case records of patients admitted to the Persahabatan Hospital (RSP), Jakarta, Indonesia, with influenza A(H5N1) confirmed by real-time polymerase chain reaction.

Twenty-two previously well patients, aged 3 to 47 years (median 24.5 years), were identified. All attended a clinic or hospital after a median of 2 days of illness (range 0–7). Times to first dose of oseltamivir (three died before receiving oseltamivir) were 2 to 12 days (median 7 days), administered mostly (n = 15) at RSP. Nineteen patients required mechanical ventilation. Deaths numbered 18 (case fatality = 82%) occurring within hours to 6 days of RSP admission, corresponding to 6 to 16 days of illness. Admission hyperglycemia (≥ 140 mg/dL), unrelated to steroids or known underlying diabetes mellitus, and elevated D-dimer levels (0.81–5.2 mg/L, upper limit of normal < 0.5 mg/L) were present in 14/21 (67%) and 20/21 (95%) patients, respectively. Fibrinogen concentrations were mostly low/normal at 129.9 to 517.9 mg/dL (median 241.1, normal 200–400 mg/dL), whereas C-reactive protein (9/11) and ferritin (6/8) levels were increased. Risk factors for death (univariate analysis) included: (1) increased D-dimers, (2) hyperglycema, (3) increased urea, (4) more extensive chest radiograph shadowing, and (5) lower admission oxygen saturation.

Early diagnosis and effective treatment of human influenza A(H5N1) infection remains challenging. Most patients were referred late with advanced disease. Oseltamivir had limited clinical impact. Elevated D-dimer levels, consistent with fibrinolysis, and hyperglycemia warrant more research to determine their underlying mechanisms and optimal treatment.