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Inicio Medicina Clínica Características clínicas y forma de presentación en pacientes con enfermedad ...
Journal Information
Vol. 160. Issue 6.
Pages 253-257 (March 2023)
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Vol. 160. Issue 6.
Pages 253-257 (March 2023)
Original breve
Características clínicas y forma de presentación en pacientes con enfermedad tromboembólica venosa y dímero-D negativo o débilmente positivo
Clinical characteristics and presentation form in patients with venous thromboembolism and negative or weakly positive D-dimer
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Pablo Demelo-Rodrígueza,b,c, Marina López-Rubioa, Crhistian-Mario Oblitasa,b,c,
Corresponding author
crhistian.cao@gmail.com

Autor para correspondencia.
, Marta Olimpia Lago-Rodrígueza, Lucía Gálvez-Rojas-Martínb, Francisco Galeano-Vallea,b,c
a Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
b Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
c Instituto de investigación sanitaria Gregorio Marañón (IiSGM), Madrid, España
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Abstract
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Resumen
Introducción

El dímero-D presenta un elevado valor predictivo negativo (VPN) para el diagnóstico de enfermedad tromboembólica venosa (ETV). Sin embargo, se ha descrito ETV en presencia de valores normales de dímero-D.

Pacientes y métodos

Estudio observacional prospectivo en pacientes con ETV en el Hospital Gregorio Marañón entre 2001-2022 que compara las características de presentación clínica en función de los niveles de dímero-D (< 500 ng/mL vs. ≥ 500 ng/mL).

Resultados

Del total de 2.582 pacientes, 333 pacientes (12,9%) presentaron dímero-D negativo o débilmente positivo. Estos eran significativamente más jóvenes (57,9 vs. 65,3 años), con menor prevalencia de comorbilidades (cardiopatía isquémica, demencia y enfermedad renal crónica), mayor historia familiar de ETV (8,4% vs. 5,2%) y trombofilia (11,7% vs. 7,8%). Presentaron significativamente menor disnea (57,6% vs. 75,4%), síncope (3% vs. 13,5%), menor carga trombótica, elevación de Nt-pro-BNP (22,0% vs. 48,2%) y dilatación del ventrículo derecho (8,1% vs. 30,0%).

Conclusión

Los pacientes con ETV y niveles bajos de dímero-D al diagnóstico fueron más jóvenes, con presentación clínica más leve y menor carga trombótica; pero presentaron mayor prevalencia de trombofilia e historia familiar de ETV.

Palabras clave:
Enfermedad tromboembólica venosa
Embolia pulmonar
Trombosis venosa profunda
Dímero-D
Anticoagulación
Abstract
Introduction

D-dimer has a high negative predictive value for the diagnosis of venous thromboembolic disease (VTE). However, VTE has been reported in the presence of normal D-dimer values.

Methods

This is a prospective observational study in patients with VTE from Hospital Gregorio Marañón between 2001 and 2022, comparing the characteristics of clinical presentation based on D-dimer levels (<500 ng/mL vs. ≥500 ng/mL).

Results

A total of 2582 patients were found, 333 patients (12.9%) presented negative or weakly positive D-dimer levels. They were significantly younger (57.9 vs. 65.3 years), with a lower prevalence of comorbidities (ischemic heart disease, dementia, and chronic kidney disease), and a greater family history of VTE (8.4% vs. 5.2%) and thrombophilia (11.7% vs. 7.8%). They presented significantly less dyspnea (57.6% vs. 75.4%), syncope (3% vs. 13.5%), less thrombotic load, elevated NT-pro-BNP (22.0% vs. 48.2%), and right ventricle dilatation (8.1% vs. 30.0%).

Conclusion

Patients with VTE and low D-dimer levels at diagnosis were younger, with milder clinical presentation and lower thrombotic load; but they presented a higher prevalence of thrombophilia and a family history of VTE.

Keywords:
Venous thromboembolism
Pulmonary embolism
Deep vein thrombosis
D-dimer
Anticoagulation

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