geoffrey modest medical blogs

new d-dimer threshhold for PE You forwarded this message on Mon 1/6/2020 8:08 AM  You forwarded this message on Mon 1/6/2020 8:08 AM G      Geoff A. Modest, M.D. Mon 1/6/2020 8:06 AM Geoff A. Modest, M.D.  A recent Canadian study suggested that we could use higher d-dimer cutpoints in ruling out pulmonary embolism, which might lead to significant decreases in radiation exposure, per the Pulmonary Embolism Graduated d-dimer or PEGeD study (see  dvt pe ddimer threshold nejm2019  in dropbox or DOI: 10.1056/NEJMoa1909159 ) Details: -- 2017 patients were enrolled from 2016-2018 in this prospective study to see how effective it was to use a d-dimer cutpoint of <1000 ng/mL in those with low clinical pretest probability of a PE (C-PTP), or <500 ng/mL in those with moderate C-PTP -- mean age 52, 66% female, mean weight 81 kg, median of ...

A large 10-year analysis found that the risk of recurrent venous thromboembolism (VTE) after an unprovoked initial VTE increased signficantly after taking only 3-6 months of anticoagulation (see  dvt unprovoked longterm anticoag bmj2019  in dropbox, or d oi.org/10.1136/bmj.l4363. Details: --18 studies with 7515 patients were analyzed (4 studies were prospective observational cohort studies; 14 were RCTs); all were considered high-quality studies --they did not include studies with: persistent risk factors of patients having active cancer; major transient risk factors of surgery with anesthesia for >30 minutes, confined to bed for >2 days with acute illness, or C- section; minor transient risk factors of surgery with anesthesia for < 30 minutes, admitted to  hospital for < 3 days with acute illness, estrogen therapy, pregnancy/puerperium, confined to bed outside of hospital for >2 days, or leg injury ...

A recent study looked at the 5 year incidence of recurrent VTE in men and women who stopped anticoagulants after an unprovoked VTE and had negative d-dimer both before stopping therapy and one month afterwards. This is a follow-up to their 2. 2 year results (see prior article eval/blog: https://gmodestmedblogs.blogspot.com/2015/01/stopping-anticoagulation-after-first-dvt.html ), confirming that the incidence of recurrence was very high in men, lower in women, and quite low in those women who were on estrogens and stopped them (see dvt normal d-dimer not help jthrombhem2019 in dropbox, or DOI: 10.1111/jth.144). Details: -- 410 patients in the initial prospective interventional cohort study, who had 3 to 7 months of oral anticoagulants (OACs) with INR goal of 2.0-3.0; d-dimer was negative on therapy and still negative one month subsequently. -- Women who had a VTE while on estrogen therapy were eligible if they stopped estrogen therapy -- mean age 51, BMI 31, duration o...