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Published in:

01-12-2006

Is D-dimer a Predictor of Strangulated Intestinal Hernia?

Authors: Gokhan Icoz, MD, Ozer Makay, MD, Murat Sozbilen, MD, Baris Gurcu, MD, Cemil Caliskan, MD, Ozgur Firat, MD, Zahide Kurt, MD, Sinan Ersin, MD

Published in: World Journal of Surgery | Issue 12/2006

Abstract

Background

The goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia.

Methods

Consecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis.

Results

Thirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels.

Conclusions

To help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.

Lange H, Jackel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 1994;160:381–384PubMed

Pott FE IV, Vukov LF. Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci 1999;54:M55–M58

Salzano A, DeRosa A, Carbone M, et al. Computerized tomography features of intestinal infarction: 56 surgically treated patients with reversible mesenteric ischemia. Radiol Med 1999;97:246–250

Horgan PG, Gorey TF. Operative assessment of intestinal viability. Surg Clin North Am 1992;72:143–155PubMed

Schoots IG, Levi M, Roossink EHP, et al. Local intravascular coagulation and fibrin deposition on intestinal ischemia–reperfusion in rats. Surgery 2003;133:411–419PubMedCrossRef

Acosta S, Nilsson TK, Björck M. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia. Br J Surg 2001;88:385–388PubMedCrossRef

Acosta S, Bjorck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 2003;26:179–183PubMedCrossRef

Altinyollar H, Boyabatli M, Berberoglu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 2006;117:463–467PubMedCrossRef

Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J 2003;20:319–325PubMedCrossRef

10.

Bick RL, Baker WF. Diagnostic efficacy of the D-dimer assay in disseminated intravascular coagulation (DIC). Thromb Res 1992;65:785–790PubMedCrossRef

11.

Harrison KA, Haire WD, Pappas AA, et al. Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus. J Nucl Med 1993;34:896–898PubMed

12.

Meissner MH, Zierler BK, Bergelin RO, et al. Markers of plasma coagulation and fibrinolysis after acute deep venous thrombosis. J Vasc Surg 2000;32:870–880PubMedCrossRef

13.

Fujii J, Takeuchi S, Harada A, et al. Hemostatic activation in spontaneous intracerebral hemorrhage. Stroke 2002;32:883–890

14.

Danesh J, Whincup P, Walker M, et al. Fibrin D-dimer and coronary heart disease. Circulation 2001;103:2323–2327PubMed

15.

Quick G, Eisenberg P. Bedside measurement of D-dimer in the identification of bacteremia in the emergency department. J Emerg Med 2000;19:217–223PubMedCrossRef

16.

Engelman DT, Gabram SGA, Allen L, et al. Hypercoagulability following multiple trauma. World J Surg 196;20:5–10

17.

Kobayashi T, Tokunaga N, Sugimura M, et al. Predictive values of coagulation/fibrinolysis parameters for the termination of pregnancy complicated by severe preeclampsia. Semin Thromb Hemost 2001;27:137–141PubMedCrossRef

18.

Lip GY, Rumley A, Dunn FG, et al. Plasma fibrinogen and fibrin D-dimer in patients with atrial fibrillation. Int J Cardiol 1995;51:245–251PubMedCrossRef

19.

Lowe GDO, Rumley A. Use of fibrinogen and fibrin D-dimer in prediction of arterial thrombotic events. Thromb Haemost 1999;82:667–672PubMed

20.

Gutierrez A, Sanchez-Paya J, Marco P, et al. Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage. J Clin Gastroenterol 2001;32:315–318PubMedCrossRef

21.

Oya M, Akiyama Y, Okuyama T, et al. High preoperative D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer. Jpn J Clin Oncol 2001;31:388–934PubMedCrossRef

22.

Lowe GD, Yarnell JW, Rumley A, et al. C-reactive protein, fibrin D-dimer, and incident ischemic heart disease in the Speedwell Study: are inflammation and fibrin turnover linked in pathogenesis? Arterioscler Thromb Vasc Biol 2001;21:603–610PubMed

23.

Pieper CF, Rao KM, Currie MS, et al. Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons. J Gerontol Med Sci 2000;55:M649–M657

24.

Giavarina D, Mezzena G, Dorizzi RM, et al. Reference interval of D-dimer in pregnant women. Clin Biochem 2001;34:331–333PubMedCrossRef

25.

Larsen JF, Ejstrud P, Svendsen F, et al. Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy. Br J Surg 2001;88:1001–1005PubMedCrossRef

26.

Karimova A, Pinsky DJ. The endothelial response to oxygen deprivation: biology and clinical implications. Intensive Care Med 2001;27:19–31PubMedCrossRef

27.

Biemond BJ, Levi M, Ten Cate H, et al. Plasminogen activator and plasminogen activator inhibitor I release during experimental endotoxaemia in chimpanzees: effect of interventions in the cytokine and coagulation cascades. Clin Sci 1995;88:587–594PubMed

Title: Is D-dimer a Predictor of Strangulated Intestinal Hernia?
Authors: Gokhan Icoz, MD
Ozer Makay, MD
Murat Sozbilen, MD
Baris Gurcu, MD
Cemil Caliskan, MD
Ozgur Firat, MD
Zahide Kurt, MD
Sinan Ersin, MD
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0138-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is D-dimer a Predictor of Strangulated Intestinal Hernia?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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