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RELATIONSHIP BETWEEN D-DIMER LEVELS AND DELAYS IN DIAGNOSIS OF PULMONARY THROMBOEMBOLISM

RELATIONSHIP BETWEEN D-DIMER LEVELS AND DELAYS IN DIAGNOSIS OF PULMONARY THROMBOEMBOLISM. Savaş Özsu ¹ , Yılmaz Bülbül ¹ , Funda Öztuna ¹ ,Polat Koşucu ² , Tevfik Özlü ¹ 1- Departments of Chest Diseases, 2- Radiology. Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

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RELATIONSHIP BETWEEN D-DIMER LEVELS AND DELAYS IN DIAGNOSIS OF PULMONARY THROMBOEMBOLISM

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  1. RELATIONSHIP BETWEEN D-DIMER LEVELS AND DELAYS IN DIAGNOSIS OF PULMONARY THROMBOEMBOLISM Savaş Özsu¹, Yılmaz Bülbül ¹, Funda Öztuna ¹ ,Polat Koşucu² , Tevfik Özlü ¹1- Departments of Chest Diseases, 2-Radiology. Karadeniz Technical University, School of Medicine, Trabzon, Turkey

  2. Introduction • Earlier diagnoses of PTE may reduce the mortality • 17%- 30% of patients with acute PE were diagnosed more than a week • There are only a limited number of studies delays in the diagnosis PTE Stein PD.Chest 1995; 108: 978, Bülbül Y. Respiration, Elliott CG.Chest 2005

  3. Aim • To investigate the association between d-dimer levels and delays in diagnosis of PTE

  4. Methods-I • 305 patients with PTE diagnosed in our hospital between June 2001 and December 2008 were evaluated retrospectively • Diagnostic tests • in 92% with spiral BT • in 5.9 % with lung scan • in 2% with clinic

  5. Methods-II • Diagnostic delay from symptom onset to definitive diagnosis • D-dimer levels measured at the time of diagnosis were recorded • Measurement of d-dimer was done by ELISA method • D-dimer level ≤ 500 ng/mL was accepted normal

  6. Results-I • 174 female-131 male, the mean age 62.9±16/years • D-dimer, %3 was normal • >4000 ng/ml cut-off value of D-dimer for diagnostic period was found • were grouped according to range of D-dimer into two categories • ≤4000 ng/ml group-I,148 pts (the mean value:2.05±1.1) • >4000 ng/ml grup-II,157 pts (the mean value:15.83±12.4)

  7. Results-II • The mean delay to diagnosis 6,8±8.7 day • In group-I 7,8±9.3 day, • In group-II 5,9±8.0 day(p=0,012) • Dyspnea and/or syncope were more frequent in group II (p=0,021 and p=0,022, respectively).

  8. Results-III • The frequency of massive embolism (based on TA<90/60 mm-Hg) • 9.4% in group I • 17.8% in group II (p=0,034). • No difference between the two groups and risk factors for PTE(cancer, heart failure, cv accident,surgery…) • Mortality rates were not statistically (11 pts in group I’de, and 18 pts in group II).

  9. Results-IV • D-dimer>4000 ng/ml • Masive PTE • Dyspnea and/or syncope • Earlier diagnosis more frequent • Mortality no change No difference are risk factors for PTE • This study supports the view that reduce the mortality of early diagnosis 

  10. Discussion-I • Reembolism • Mortality is related to D-dimer levels • D-dimer is a nonspesifik marker • Surgery • Atelectasis • Hypotension is associated with early diagnosis Ghanima W. Thrombosis res.2007;120:281, Castro DJ.Thrombosis res 2007;121.153, Bulbul Y.Respiration(in press)

  11. Discussion-II • D-dimer levels related to the extent of thrombus are • Clinic severity reflects the extent of thrombus • This situation led to refer patients to early  • As a result, early applicants may affect mortality  .

  12. Limititations • Retrospective • D-dimer levels were compared with clinical findings  • Echocardiography,CT findings no performed • Do not know the long term results (?)

  13. TEŞEKKÜRLER

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