{"id":271,"date":"2020-09-04T19:25:44","date_gmt":"2020-09-04T19:25:44","guid":{"rendered":"https:\/\/www.hospitalinnovate.org\/covid19\/?p=271"},"modified":"2020-09-21T23:27:31","modified_gmt":"2020-09-21T23:27:31","slug":"8how-should-d-dimer-be-interpreted-in-the-setting-of-covid-19","status":"publish","type":"post","link":"https:\/\/www.hospitalinnovate.org\/covid19\/2020\/09\/04\/8how-should-d-dimer-be-interpreted-in-the-setting-of-covid-19\/","title":{"rendered":"08. How should D-dimer be interpreted in the setting of COVID-19?"},"content":{"rendered":"

[vc_row full_width=”stretch_row_content_no_spaces” equal_height=”yes” content_placement=”bottom” css=”.vc_custom_1599595660271{margin-top: 0px !important;border-bottom-width: 4px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 0px !important;padding-left: 20px !important;background-color: #f2f2f2 !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;}”][vc_column width=”2\/3″ css=”.vc_custom_1599247143020{padding-right: 20px !important;padding-left: 10px !important;}”][vc_custom_heading text=”Prevention and Treatment of Venous Thromboembolism Key Clinical Questions” font_container=”tag:h2|text_align:left|color:%23f7941d” use_theme_fonts=”yes” css=”.vc_custom_1599247161415{margin-top: 0px !important;padding-top: 40px !important;}”][\/vc_column][vc_column width=”1\/3″][vc_column_text]<\/p>\n

Home<\/a> \/ VTE Overview<\/a> \/ VTE Clinical Questions<\/a><\/p>\n

[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” gap=”20″][vc_column width=”3\/4″ css=”.vc_custom_1599595157356{padding: 20px !important;}”][vc_custom_heading source=”post_title” use_theme_fonts=”yes”][vc_column_text]<\/p>\n

a. HOMERuN institutions<\/strong><\/h3>\n

Fourteen percent of protocols recommended consideration of empiric therapeutic anticoagulation based on elevated D-dimer alone. Nineteen percent recommended against empiric therapeutic dosing of anticoagulation based on lab values in the absence of other clinical indications such as proven VTE. Forty-three percent recommended escalation from standard to higher-dose prophylactic anticoagulation based on laboratory findings in combination with clinical variables. For diagnostic decision-making, 14% recommended that elevated or rising D-dimer should prompt additional imaging to evaluate for VTE, while 10% instead recommended that D-dimer elevation alone should not lead to VTE work-up or empiric treatment. Several protocols mentioned that D-dimer below the upper limit of normal could still be used to exclude VTE.[\/vc_column_text][vc_row_inner gap=”30″ css=”.vc_custom_1599595185258{padding: 20px !important;}”][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

b. What is Known<\/strong><\/h3>\n

In data describing coagulation parameters among COVID-19 patients, D-dimer is elevated in approximately half. D-dimer at admission and markedly increasing D-dimer levels (3- to 4-fold) over time were associated with high mortality, likely reflecting coagulation activation from infection\/sepsis, cytokine storm and impending organ failure.5<\/a><\/sup>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

c. What is Not Known<\/strong><\/h3>\n

Although D-dimer elevation is common in COVID-19, the implications remain unknown,\u00a0including its association with hypercoagulability or overt thrombosis. In addition, how to integrate D-dimer in decisions about pharmacologic prophylaxis, diagnosis and treatment of VTE remain unknown.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1600127105482{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 4px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #2c5d73 !important;border-left-style: solid !important;border-right-color: #2c5d73 !important;border-right-style: solid !important;border-top-color: #2c5d73 !important;border-top-style: solid !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;border-radius: 4px !important;}”][vc_raw_html]JTVCdWx0aW1hdGVfcG9zdF9saXN0JTIwaWQlM0QlMjIxMjQlMjIlNUQ=[\/vc_raw_html][vc_wp_custommenu nav_menu=”3″ title=”VTE Links” el_class=”subNavButton”][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces”][vc_column][cesis_line_divider width=””][vc_column_text font_size=”10px” css=”.vc_custom_1600730846879{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #f9f9f9 !important;}”]<\/a><\/p>\n

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  1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia<\/a>. J Thromb Haemost JTH<\/em>. 2020;18(4):844-847. doi:10.1111\/jth.14768<\/li>\n<\/ol>\n

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    Nineteen percent of protocols recommended standard pharmacologic VTE prophylaxis dosing for all COVID-19 patients regardless of estimated VTE risk. Ten percent recommended…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"_links":{"self":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/271"}],"collection":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/comments?post=271"}],"version-history":[{"count":12,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/271\/revisions"}],"predecessor-version":[{"id":633,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/271\/revisions\/633"}],"wp:attachment":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/media?parent=271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/categories?post=271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/tags?post=271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}