The Clinical Significance And The Dynamic Change Of D-dimer During Thrombolysis In Patients With Acute Pulmonary Thromboembolism

Objective: To investigate the judgment of the effect of thrombolytic therapy on acutepulmonary embolism through the dynamic changes of D-dimer in plasma. Methods:62patients were admitted in the No.2Department of Respiratory in the first affiliated hospitalof Xinjiang Medical University from2010.01to2011.10for acute pulmonary embolism anddiagnosed as high or moderate risk group according to guidelines on the diagnosis andmanagement of acute pulmonary embolism of the European Society of Cardiology(ESC)in2008. They had been received thrombolytic therapy and been included in this study. Thevalues of plasma D-dimer concentration in8phases(before and after thrombolysis, per4hours in day1, day10)were recorded. Before and10days later of thrombolytic therapy,Borg dyspnea scores were evaluated and CTPA was performed. Then, the results of CTPAwere compared. Results:1) The D-dimer concertration in plasma reached the peak at4-8hof administration, as2.7fold as before administration, then returned to the level of beforeadministration at24h in the complete recanalization group (t=1.306, P=0.202); while thepartial recanalization reached the peak delayed, as2.3fold as before the treatment, anddecreased later, but remained higher than pre-administration.10days later, two groups werehigher than before administration (t=8.2, P＜0.01).2)The overall evaluation of the effect oftreatment at10days later:29cases were cured (46.7%),19cases (30.7%) were markedlyimproved, improved in13cases (21%),1case was dead for vaginal bleeding, the totalefficiency rate was98.4%.3) There is a linear correlation between the D-dimerconcertration difference (before and the peak after administration) and the number ofreduced embolized lung segment (rs=0.594, P＜0.05), between the D-dimer concertrationdifference and the improvement of dyspnea (rs=0.301, P=0.019). Conclusion: Dynamic monitor of the plasma D-dimer is a reliable method of judging the efficacy of thethrombolytic treatment. Its dynamic changes in amplitude are associated with the degree ofthrombus dissolving. We can assess the degree of thrombus dissolving according to thevariation amplitude of D-dimer in plasma.