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To scan or not to scan – D-dimers and computed tomography pulmonary angiograms in the era of COVID-19

Alexander A Tuck, Harriet L White, Badr A Abdalla, Gwendolen J Cartwright, Katherine R Figg, Emily N Murphy, Benjamin C Pyrke, Mark A Reynolds, Rana M Taha and Hasan N Haboubi
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DOI: https://doi.org/10.7861/clinmed.2020-0664
Clin Med February 2021
Alexander A Tuck
AUniversity Hospital Llandough, Cardiff and Vale University Health Board
*joint first authors.
Roles: senior house officer
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Harriet L White
AUniversity Hospital Llandough, Cardiff and Vale University Health Board
*joint first authors.
Roles: senior house officer
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Badr A Abdalla
BUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: clinical fellow gastroenterology
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Gwendolen J Cartwright
CUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: foundation year 1 doctor
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Katherine R Figg
CUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: foundation year 1 doctor
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Emily N Murphy
CUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: foundation year 1 doctor
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Benjamin C Pyrke
AUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: senior house officer
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Mark A Reynolds
DUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: specialist registrar in gastroenterology
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Rana M Taha
AUniversity Hospital Llandough, Cardiff and Vale University Health Board
Roles: senior house officer
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Hasan N Haboubi
EUniversity Hospital Llandough, Cardiff and Vale University Health Board, and senior clinical lecturer, School of Medicine, Swansea University
Roles: consultant in gastroenterology
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  • For correspondence: hasanhaboubi@doctors.org.uk
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ABSTRACT

The COVID-19 pandemic has had many ramifications on healthcare delivery and practice. As part of this, utilising biomarkers to risk stratify patients has become increasingly popular. During the COVID-19 pandemic the use of D-dimer has increased due to the evidence of COVID-19 induced thrombo-embolic disease. We evaluated the use of D-dimer on all hospital admissions during the peak of the pandemic and evaluated its sensitivity in diagnosing pulmonary embolic disease (PE). Patients without COVID-19 infection were as likely to have evidence of PE as their COVID-positive counterparts. However, the sensitivity of a D-dimer was higher in COVID-positive patients at a lower D-dimer level (>1,500 μg/L, sensitivity 81%, specificity 70%) than in those without clinical, immunological or radiological evidence of COVID-19 infection (D-dimer >2,000 μg/L, sensitivity 80%, specificity 76%). These data suggest higher D-dimer thresholds should be considered for the exclusion of pulmonary emboli.

KEYWORDS
  • D-dimer
  • CTPA
  • pulmonary embolism
  • COVID-19
  • sensitivity
  • © Royal College of Physicians 2021. All rights reserved.
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To scan or not to scan – D-dimers and computed tomography pulmonary angiograms in the era of COVID-19
Alexander A Tuck, Harriet L White, Badr A Abdalla, Gwendolen J Cartwright, Katherine R Figg, Emily N Murphy, Benjamin C Pyrke, Mark A Reynolds, Rana M Taha, Hasan N Haboubi
Clinical Medicine Feb 2021, clinmed.2020-0664; DOI: 10.7861/clinmed.2020-0664

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To scan or not to scan – D-dimers and computed tomography pulmonary angiograms in the era of COVID-19
Alexander A Tuck, Harriet L White, Badr A Abdalla, Gwendolen J Cartwright, Katherine R Figg, Emily N Murphy, Benjamin C Pyrke, Mark A Reynolds, Rana M Taha, Hasan N Haboubi
Clinical Medicine Feb 2021, clinmed.2020-0664; DOI: 10.7861/clinmed.2020-0664
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