Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism

Aysel Sunnetcioglu, Bunyamin Sertogullarindan, Bulent Ozbay, Selvi Asker, Salemi Ekin, Aysel Sunnetcioglu, Bunyamin Sertogullarindan, Bulent Ozbay, Selvi Asker, Salemi Ekin

Abstract

Objective: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism.

Material and methods: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841.

Results: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches.

Conclusion: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Box plot showing red blood cell distribution width in main pulmonary arteries and smaller arterial branches values.
Figure 2
Figure 2
Receiver operating characteristic curve of red blood cell distribution width for predicting the presence of main pulmonary arteries thrombus in studied patients.

References

    1. Alikhan R, Peters F, Wilmott R, Cohen AT. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol. 2004;57((12)):1254–7. doi: 10.1136/jcp.2003.013581.
    1. Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism a population-based study. Arch Intern Med. 2002;162((11)):1245–8. doi: 10.1001/archinte.162.11.1245.
    1. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur Heart J. 2008;29((18)):2276–315. doi: 10.1093/eurheartj/ehn475.
    1. Nielsen HK. Pathophysiology of venous thromboembolism. Thromb Hemost. 1991;17(Suppl 3):250–3.
    1. Ghanima W, Abdelnoor M. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): A proposal for a new radiological score for PE. J Int Med. 2007;261((1)):74–81. doi: 10.1111/jim.2007.261.issue-1.
    1. Ginsberg JS, Wells PS, Kearon C, Anderson D, Crowther M, Weitz JI, et al. Sensitivity and specificity of a rapid whole blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med. 1998;129((12)):1006–11. doi: 10.7326/0003-4819-129-12-199812150-00003.
    1. Karnad A, Poskitt TR. The automated complete blood cell count. Use of the red blood cell volume distribution width and mean platelet volume in evaluating anemia and thrombocytopenia. Arch Intern Med. 1985;145((7)):1270–2. doi: 10.1001/archinte.1985.00360070150025.
    1. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007;50((1)):40–7. doi: 10.1016/j.jacc.2007.02.067.
    1. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117((2)):163–8. doi: 10.1161/CIRCULATIONAHA.107.727545.
    1. Fukuta H, Ohte N, Mukai S, Saeki T, Kobayashi K, Kimura G, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50((3)):301–12. doi: 10.1536/ihj.50.301.
    1. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010;105((3)):312–7. doi: 10.1016/j.amjcard.2009.09.027.
    1. Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol. 2009;104((6)):868–72. doi: 10.1016/j.amjcard.2009.05.016.
    1. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol. 2012;109((1)):128–34. doi: 10.1016/j.amjcard.2011.08.015.
    1. Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Findik S, et al. The report for the diagnosis and therapeutical consensus of pulmonary thromboembolism. Tur Toraks Der. 2009;10((11)):7–47.
    1. Tapson VF, Witty LA. Massive pulmonary embolism. Clin Chest Med. 1995;16((2)):329–40.
    1. Dahnert W. Dahnert W, Pulmonary thromboembolism disease Radiology Review Manual. 1999Philadelphia: Williams & Wilkins; 431–2.
    1. Oser RF, Zuckerman DA, Gutierrez FR, Brink JA. Anatomic distribution of pulmonary trombus at pulmonary angiography: Implications for cross-sectional imaging. Radiology. 1996;199((1)):31–5. doi: 10.1148/radiology.199.1.8633168.
    1. Şimşek A, Türkkan Ö, Melek K, Eyüboğlu FÖ. Assessment of Patients with Pulmonary Thromboembolism (PTE) Diagnosed in Our Clinic: 5 Years Experience. Tur Toraks Der. 2010;11:149–54. doi: 10.5152/ttd.
    1. Gülcü A, Akkoçlu A, Yilmaz E, Öztürk B, Osma E, Şengün B. The comparison of the clinical probability with computed tomography pulmonary angiography findings for the pulmonary embolism (PE) diagnosis. Tuberk Toraks. 2007;55((2)):174–81.
    1. Şen E, Arslan F, Eladağ Yurt S, Tarakçi N, Kaya A, Atasoy Ç, et al. The clinical and radiological findings of the patients diagnosed with pulmonary thromboembolism by pulmonary computed tomography angiography. Tuberk Toraks. 2009;57((1)):5–13.
    1. Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352((17)):1760–8. doi: 10.1056/NEJMoa042905.
    1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism clinical outcomes in the International Cooperative Pulmonary embolism Registry (ICOPER) Lancet. 1999;353((9162)):1386–9. doi: 10.1016/S0140-6736(98)07534-5.
    1. Timmons S, Kingston M, Hussain M, Kelly H, Liston R. Pulmonary embolism differences in presentation between older and younger patients. Age Ageing. 2003;32((6)):601–5. doi: 10.1093/ageing/afg098.
    1. Le Gal G, Righini M, Roy PM, Meyer G, Aujesky D, Perrier A, et al. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age. J Thromb Haemost. 2005;3((11)):2457–64. doi: 10.1111/jth.2005.3.issue-11.
    1. De Monye W, Sanson BJ, Mac Gillavry MR. ANTELOPE Study Group. Embolus location affects the sensitivity of a rapid quantitative D-dimer assay in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 2002;165((3)):345–8. doi: 10.1164/ajrccm.165.3.2104099.
    1. Şen N, Ermiş H, Altinkaya N. Young and Old pulmonary embolism (PE) cases included; Clinical features, laboratory and instrumental findings and differences according to age group. Tur Toraks Der. 2010;11:160–6. doi: 10.5152/ttd..
    1. Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Ross S, Sandset PM. D-dimer level is associated with the extent ofpulmonary embolism. Thromb Res. 2007;120((2)):281–8. doi: 10.1016/j.thromres.2006.08.006.
    1. Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T. Prognostic Value of Red Cell Distribution Width in Patients With Pulmonary embolism. Clin Appl Thromb Hemost. 2014;20((4)):365–70. doi: 10.1177/1076029612464901.
    1. Cay N, Unal O, Kartal MG, Ozdemir M, Tola M. Increased level of red blood cell distribution width is associated with deep venous thrombosis. Blood Coagul Fibrinolysis. 2013;24((7)):727–31. doi: 10.1097/MBC.0b013e32836261fe.
    1. Rezende SM, Lijfering WM, Rosendaal FR, Cannegieter SC. Hematological variables and venous thrombosis: red cell distribution width and blood monocytes are associated with an increased risk. Haematologica. 2014;99((1)):194–200. doi: 10.3324/haematol.2013.083840.

Source: PubMed

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