The role of D-dimer in patients with covid-۱۹ and suspected pulmonary embolism

Introduction and objective: D-dimer, which is produced as a result of the destruction of fibrin strands, is a prothrombotic biomarker whose level increases in patients with severe SARS-Cov-۲ infection, due to an increase in the level of inflammation and activation of coagulation. The most common thrombotic complication in these patients, which occurs after the increase of D-dimer, is pulmonary embolism (PE). The overlap of clinical manifestations of Covid-۱۹ infection and PE can make accurate diagnosis challenging in these patients.Search Methods: In the upcoming narrative study, the required data were collected by using keywords and citing valid databases such as: Science Direct , PubMed, Google Scholar and ProQuest. The statistical population of the study includes all studies conducted up to ۲۰۲۲ in the field of the role of D-dimer in patients with covid-۱۹ and suspected pulmonary embolism. After reviewing the relevant Results and evaluating the data quality, a total of ۲۳ articles were analyzed.Results: History of diabetes, high sugar and lactate, as well as age and BMI have a direct relationship with the probability of PE.D-dimer test is usually reported as positive and negative considering the threshold of ۵۰۰ ng/ml and can be a safe tool to rule out PE. But this characteristic is reduced in patients with Covid-۱۹ due to the high level of D-dimer even in the absence of pulmonary embolism. As a result, it is felt necessary to consider new D-dimer algorithms or thresholds so that the patient does not suffer unnecessary treatment with anticoagulants and complications. Also, to prevent unnecessary CTPA (Computed Tomography Pulmonary Angiogram) which, in addition to entering radiation into the patient's body, is expensive and time-consuming, and is prohibited for use in patients with kidney damage or hemodynamic instability.Conclusion: Among the studies, the D-dimer threshold considered to rule out PE in patients with Covid-۱۹ has been varied between ۹۰۰ and ۲۹۰۳ ng/ml. However, the resulting sensitivity to rule out PE at the considered threshold, regardless of clinical probability assessment, is still considered unsafe.Also, the use of algorithms based on age-adjusted D-dimer thresholds is recommended, especially for patients over ۵۰ years old.

کلیدواژه ها:

Pulmonary embolism ، D-dimer ، Covid-۱۹ ، Diagnosis