Evaluation of D-dimer levels in patients with prosthetic valve thrombosis: relationship with thrombus burden and cerebrovascular events. Issue 3 (April 2018)

• Record Type: Journal Article
• Authors: Cerşit, Sinan; Gündüz, Sabahattin; Bayam, Emrah; Güner, Ahmet; Kalkan, Semih; Kalçık, Macit; Karakoyun, Süleyman; Gürsoy, Mustafa Ozan; Yesin, Mahmut; Candan, Özkan; Özkan, Mehmet
• Is Part Of: Blood coagulation and fibrinolysis. Volume 29:Issue 3(2018)
• Publication Date: 2018-04
• Subjects: cerebrovascular accident -- D-dimer -- prosthetic heart valve -- thrombosis -- transesophageal echocardiography -- transient ischemic attack; Blood -- Coagulation -- Periodicals; Fibrinolysis -- Periodicals; Hemostasis -- Periodicals; Thrombosis -- Periodicals; Blood Coagulation -- Periodicals; Fibrinolysis -- Periodicals; Hemostasis -- Periodicals; Thrombosis -- Periodicals; 612.115
• DOI: 10.1097/MBC.0000000000000722
• Languages: English
• ISSNs: 0957-5235

Abstract

Abstract : N/A: Plasma D-dimer level is an indicator of thrombosis and endogenous fibrinolytic activity. We investigated the association between the D-dimer levels and thrombus burden and cerebrovascular events in patients with obstructive prosthetic valve thrombosis (PVT). This retrospective study included 47 patients with obstructive left-sided PVT and 32 controls in whom PVT was excluded with comprehensive transthoracic and transesophageal echocardiography (TEE). The patient group included 11 aortic, 27 mitral, and 9 aortic and mitral valve PVT patients and the control group included 2 aortic, 25 mitral, and 5 aortic and mitral valve patients. Laboratory analysis including plasma D-dimer levels was performed at the time of admission in all patients. The baseline characteristics were similar between the two groups. The plasma D-dimer levels were significantly higher in patients with obstructive PVT compared with controls [680 (110–3590) vs. 310 (80–380) μg/l; P < 0.001]. By multivariate logistic regression analysis high D-dimer level, low-INR value on admission, high NYHA functional class and recent history of cerebrovascular accident (CVA), and transient ischemic attack (TIA) were the independent predictors of obstructive PVT. A plasma D-dimer level of greater than 365 μg/l predicted the presence of PVT with a sensitivity of 81% and a specificity of 69% (AUC= 0.781, P < 0.001). Plasma D-dimer levels were significantly higher in patients with a recent history of CVA/TIA [2140 (470–2980) vs. 590 (380–830) μg/l; P = 0.021]. In addition to the so-called indicators of PVT including subtherapeutic anticoagulation, increased D-Dimer levels may strengthen the suspicion of PVT. Moreover, higher plasma D-dimer levels were associated with higher thrombus burden and higher prevalence of recent CVA/TIA.