As per a research article posted on Oct. 8 in JAMA Network Access, using D-dimer levels to rule out pulmonary embolism (PE) has minimal therapeutic relevance. Hence, it might be inappropriate in individuals hospitalized with COVID-19 who have elevated plasma D-dimer readings.
D-Dimer Level Not Beneficial In COVID-19 Patients
In different nations, the D-Dimer level has been considered one of the prime parameters to diagnose a patient’s medical condition after having an infection from Covid-19. However, with this new research, the experts have come forward with a different conclusion mentioning this level as not an effective or concrete option to understand the infection in the body and hence make no more use of the same in deciding the line of treatment.
A treatment outcome research was undertaken by Constantine N. Logothetis, M.D., and colleagues to characterize the efficacy of D-dimer to exclude PE in individuals hospitalized with COVID-19.
Plasma D-dimer levels using an automated, standardized test match the criteria standards of computerized tomographic bronchial angiogram in 287 individuals with probable PE. This was investigated if plasma D-dimer levels could appropriately characterize individuals having PE.
118 of the 287 individuals with COVID-19 and probable PE needed intensive care treatment, and 27 have perished while in the clinic. The scientists discovered that just 37 individuals exhibited radiological signs of PE, whereas the remaining 87.1% had not. Furthermore, 92.3% of individuals, such as all individuals having PE and 225 of 250 individuals lacking PE, exhibited plasma D concentrations of less than 0.05 g/mL.
That means D-dimer levels for individuals lacking and overall PE were 1.0 and 6.1 g/mL, correspondingly; D-dimer levels varied between 0.2 to 128 g/mL & from 0.5 to greater than 10,000 g/mL. Individuals lacking PE had considerably reduced median D-dimer levels.
“These results suggest that the use of D-dimer levels to exclude PE among patients hospitalized with COVID-19 may be inappropriate and have limited clinical utility,” the authors write.
The avoidance and therapy of thrombus must be considered when treating COVID-19 individuals. Responsive thrombocytosis was identified in 4% of individuals, which can be linked to an elevated incidence of thrombus.
Furthermore, service users with COVID-19 may have risen blood surface tension due to elevated fever as well as inordinate perspiring, as well as a hypercoagulable condition due to clotting induced changes activation, which, when combined with threat variables including such lengthy bed rest, adiposity, and advanced age, increases the danger of thrombus. The therapeutic usefulness of D-dimer values in COVID-19 individuals on thrombus development is unknown.
It’s worth debating whether greater D-dimer concentrations in COVID-19 individuals indicate the need for more severe anticoagulant medication. Recent research found that high D-dimer concentrations in patients were similar to those found in individuals having a pulmonary embolism, lowering the test’s accuracy in the differentiated identification of CAP and deep vein thrombosis.
As revealed in our research, D-dimer levels fell as inflammatory subsided and the condition improved, implying that it is not realistic to determine if anticoagulation is required only based on D-dimer concentrations. The low association between Padua VTE score with D-dimer concentrations further decreased D-significance dimers in thrombus prognosis.
This begs the issue of what signs should be utilized to advise vein thrombosis prevention in COVID-19 individuals. Surprisingly, not all individuals’ D-dimer levels fell when inflammation variables fell, implying the likelihood of thrombosis. It must be highlighted that anticoagulant medication is required if D-dimer levels do not synchronize with the resolution of inflammation.
In particular, VTE risk evaluation must be taken into account while determining medical decisions. Since COVID-19 death rises with time and older individuals are more prone to experience bleed episodes, hemorrhage ratings must be factored into therapeutic considerations.