VPB0979 - Use of D-dimer for the exclusion of new pulmonary embolism in anticoagulated patients: A multicenter retrospective study

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Co-Author(s)

EB

Etienne Beaudoin

Internal medecine resident
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
SK

Shaima Kaka

medical student
University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
EG

Elisabeth Gagnon

Internal medecine resident
Centre Hospitalier Universitaire de Sherbrooke / Université de Sherbrooke
Sherbrooke, Quebec, Canada
AD

Andreanne Durivage

Internist
Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke
Sherbrooke, Quebec, Canada
IB

Isabelle Boulais

Internist
Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke
Sherbrooke, Quebec, Canada
GL

Genevieve Le Templier

Internist
Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke
Sherbrooke, Quebec, Canada
DT

Dominique Toupin

Hemato-oncologist
Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke
Sherbrooke, Quebec, Canada
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Presenting Author(s)

Bobby Gouin, MD

Internist
Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke
Sherbrooke, Quebec, Canada

Background: The use of plasma D-dimer level to exclude pulmonary embolism (PE) in low-intermediate risk non-anticoagulated patients has been well studied. However, its use for patients on chronic direct-acting oral anticoagulant (DOAC) therapy is unclear.

Aims: We aimed to evaluate D-dimer performance for the exclusion of PE among patients on DOACs who presented to the emergency department (ED) and underwent lung imaging for clinically suspected PE.

Methods: Patients aged ≥ 18 years on DOAC therapy who presented to the ED between January 2010 and June 2019 and had, in one visit (or in two visits within two days), a plasma D-dimer measurement and an imaging test to assess PE (CT pulmonary angiography or ventilation-perfusion scintigraphy) were included. The primary outcome was to evaluate the diagnostic accuracy of a negative D-dimer in the exclusion of a new PE.

Results: Our study included 109 patients. Only four patients (3.7%) had a new diagnosis of PE, of which two had active cancer. The sensitivity of abnormal conventional or age adjusted D-dimer thresholds to detect PE in this population was 100.0% (95%CI 39.8-100.0) for both thresholds, whilst the negative predictive value to exclude PE in this population was 100.0% (95%CI 91.8-100.0 and 93.8-100.0 respectively for each D-dimer threshold).

Conclusion(s): In patients on chronic DOAC therapy, plasma D-dimer level appears to have a high sensitivity and a high negative predictive value. This study suggests a possible role of plasma D-dimer level in the exclusion of PE among patients on DOAC therapy with a clinical suspicion of PE. However, these findings are hypothesis-generating only, and further studies are required.