Analysis Of Normal D-dimerlevel In Patients With Pulmonary Thromboembolism

Objective: In order to enhance the understanding of pathological development ofpulmonary thromboembolism and improve the recognition of the relationship between theD-dimer and coagulation fibrinolytic system, as well as get across to the D-dimer dynamics inthe process of thromboembolism, we analyze the clinical features of patients with pulmonarythromboembolisminanormalD-dimerlevel.Materials and Methods: Thirty eight patients with pulmonary thromboembolism whowere diagnosed through CT pulmonary angiography or coronary angiography in the FirstAffiliated Hospital of Dalian Medical University from January1,2009, to June1,2013wereretrospectively included in the study. They underwent plasma D-dimer test in the beginning ofadmission and the test results were normal. Data were collected on a series of clinicalcharacteristics including basic disease, risk factors, clinical manifestation, auxiliaryexaminations, treatment, outcome, and so on.The D-dimer assay used in our hospital isautomatedquantitativeimmunoturbidimetricassay.Results: The mean±standard deviation patient age was65.87±11.29years. Theattendance duration once they had symptoms ranged from five hours to sixty days,the average admission duration was nine days, and twenty of them visit doctors aftertwo weeks they had symptoms.20patients (52.6%) were hospitalized in the department of cardiology.32patients (84.2%) had medical history such as cardio-cerebrovascular diseases, endocrine diseases, fracture or surgery.10patients (26.3%) simultaneouslyhad3or more risk factors. For the chief complaint,22patients (57.9%) had dyspnea,17patients (44.7%) felt chest pain, and hemoptysis occurred in4patients (10.5%).Only one case of patients (2.6%) simultaneously had above triad syndrome. Syncope occurred in3patients (two of them combined with acute myocardialinfarction).9patients (23.7%) had clinical signs of lower limb DVT (swelling and/or pain). Resultsof the Wells score: cases of low, moderate and high clinical probability respectivelywere15,17and6(39.5%,44.8%and15.7%).37patients underwent lower limbvenous ultrasonography and/or computed tomographic venography, and12cases hadDVT. All the patients were confirmed with computed tomography pulmonary angiogra-phy. Among them,3cases (7.9%) of emboli were located in the pulmonary trunk,30cases (78.9%) were segmental emboli, and the rest5cases (13.2%) were subsegm-ental emboli. Risk stratification:21cases (55.3%) were low risk PTE, and17cases(44.7%) were intermediate risk PTE. All patients discharged with the symptomsrelieved.Conclusions:1.ThefalsenegativeresultscanbereducebyadoptinghighlysensitiveD-dimerassays.2. The Combination of low or moderate clinical probability with a normal level ofD-dimer wouldhighersafelyexcludePTE.