Increases in D-dimer levels are noticed in immediate post-operative period. Most appropriate cause is
a) DVT
b) Pulmonary embolism
c) DIC
d) Normal
Ans: A Reference: Sabiston 20th ed; pg. 295 Explanation:
• D dimer is a degradation product of a cross linked fibrin blood clot. • Increased levels are typically elevated in patients with acute thromboembolism • D- dimer will increase only if thrombus has occurred and also with fibrinolysis. • Presence of D-dimers in the circulation may serve as a marker of thrombosis or other conditions in which a significant activation of the fibrinolytic system is present. • Elevated D dimer should be followed by Venous Duplex ultrasound of the extremities for diagnosing DVT. • If there is a homogenous hypoechoic clot, without compressibility of the vein and absence of flow across it confirms the diagnosis • Initial treatment is with Low molecular weight heparin Enoxaparin 1.5mg/kg/day subcutaneous twice daily along with Warfarin 5mg on day 1, 5 mg on day 2 and then 10 mg thereafter. • Heparin overlap to be given for 5 days, as the anticoagulant action of warfarin takes 5 doses. • Maintain INR 2.5 for DVT for 3 months, once recanalization of vein occurs, anticoagulants can be withheld.