1. ʻO ka hoʻohana ʻana o D-Dimer i nā poʻe maʻi me COVID-19: Ma kahi ʻano, ʻo COVID-19 kahi maʻi thrombotic i hoʻoulu ʻia e nā maʻi immune, me ka diffuse inflammatory pane a me ka microthrombosis i loko o ka māmā.Ua hōʻike ʻia ʻoi aku ma mua o 20% o nā mea maʻi me VTE i nā maʻi maʻi maʻi o COVID-19.

• ʻO nā pae D-Dimer ma ke komo ʻana i wānana kūʻokoʻa i ka make i loko o ka haukapila a nānā ʻia i nā poʻe maʻi pilikia nui.I kēia manawa, ua lilo ʻo D-dimer i kekahi o nā mea nānā nui no nā maʻi me COVID-19 i ka wā i hoʻokomo ʻia ai lākou i ka haukapila.

• Hiki ke hoʻohana ʻia ʻo D-Dimer e alakaʻi i ka hoʻomaka ʻana o ka heparin anticoagulation i nā maʻi me COVID-19.Ua hōʻike ʻia i nā mea maʻi me D-Dimer ≥ 6-7 mau manawa i ka palena kiʻekiʻe o ka pae kuhikuhi, hiki i ka hoʻomaka ʻana o ka heparin anticoagulation hiki ke hoʻomaikaʻi nui i nā hopena maʻi.

• Hiki ke hoʻohana ʻia ka nānā ʻana o D-Dimer no ka nānā ʻana i ke ʻano o ka VTE i nā maʻi me COVID-19.

• Nānā D-Dimer, hiki ke hoʻohana ʻia e loiloi i ka hopena o COVID-19.

• Ka nānā 'ana o D-Dimer, i ka wā e ho'oholo ai ka mālama 'ana i ka ma'i, hiki anei iā D-Dimer ke hā'awi i kekahi 'ike kuhikuhi?Nui nā hoʻokolohua lapaʻau ma waho e nānā ʻia nei.

2. Hōʻike ka D-Dimer dynamic monitoring i ka hoʻokumu ʻana o VTE:

E like me ka mea i ʻōlelo ʻia ma luna, ʻo ka hapalua o ke ola o D-Dimer he 7-8h.Ma muli o kēia hiʻohiʻona hiki iā D-Dimer ke nānā ikaika a wānana i ka hoʻokumu ʻana o VTE.No ke kūlana hypercoagulable transient a i ʻole microthrombosis, e piʻi iki ka D-Dimer a laila e emi koke.Ke hoʻomau nei ka hoʻokumu ʻana o ka thrombus hou i loko o ke kino, e piʻi mau ana ka D-Dimer i ke kino, e hōʻike ana i kahi pihi piʻi e like me ka piko.No nā poʻe me kahi kiʻekiʻe o ka thrombosis, e like me nā hihia koʻikoʻi a koʻikoʻi, nā maʻi postoperative, a me nā mea ʻē aʻe, inā piʻi wikiwiki ka pae D-Dimer, e makaʻala i ka hiki ke thrombosis.I loko o ka "Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", ua ʻōlelo ʻia e nānā pono nā mea maʻi me ka liʻiliʻi a me ke kiʻekiʻe ma hope o ke kaʻina orthopedic i nā loli o D-Dimer i kēlā me kēia 48 hola.Pono e hana ʻia nā hoʻokolohua kiʻi i ka manawa kūpono e nānā i ka DVT.

3. D-Dimer ma ke ʻano he hōʻailona prognostic no nā maʻi like ʻole:

Ma muli o ka pilina pili ma waena o ka ʻōnaehana coagulation a me ka mumū, ka ʻeha endothelial, a me nā mea ʻē aʻe, ʻike pinepine ʻia ka piʻi ʻana o D-Dimer i kekahi mau maʻi non-thrombotic e like me ka maʻi, ka ʻokiʻoki a i ʻole ka trauma, ka puʻuwai naʻau, a me nā maʻi ʻino.Ua ʻike nā haʻawina ʻo ka maʻi maʻamau maʻamau o kēia mau maʻi he thrombosis, DIC, a me nā mea ʻē aʻe.No laila, hiki ke hoʻohana ʻia ʻo D-Dimer ma ke ʻano he loiloi loiloi ākea a maʻalahi no nā maʻi.

• No nā poʻe maʻi maʻi maʻi maʻi, ua ʻike kekahi mau haʻawina he haʻahaʻa loa ka helu ola 1-3 makahiki o nā maʻi maʻi maʻi me ka D-Dimer kiʻekiʻe ma mua o nā maʻi D-Dimer maʻamau.Hiki ke hoʻohana ʻia ʻo D-Dimer ma ke ʻano he hōʻailona no ka loiloi ʻana i ka prognosis o nā maʻi maʻi maʻi maʻi.

• No nā poʻe maʻi VTE, ua hōʻoia nā haʻawina he nui i ka poʻe maʻi D-Dimer-positive me VTE he 2-3 mau manawa kiʻekiʻe o ka hoʻi hou ʻana o ka thrombus i ka wā anticoagulation ma mua o nā maʻi maikaʻi ʻole.ʻO kekahi meta-analysis me 7 mau haʻawina me ka huina o 1818 mau kumuhana i hōʻike ʻia, ʻo Abnormal D-Dimer kekahi o nā wānana nui o ka hoʻi hou ʻana o ka thrombus i nā maʻi VTE, a ua hoʻokomo ʻia ʻo D-Dimer i loko o nā hiʻohiʻona wanana hoʻi hou VTE.

• No nā poʻe maʻi mechanical valve replacement (MHVR), ua hōʻike kahi haʻawina lōʻihi o ka hahai ʻana o nā kumuhana 618 i ka pilikia o nā hanana ʻino i nā maʻi me nā pae D-Dimer abnormal i ka wā warfarin ma hope o MHVR ma kahi o 5 mau manawa o nā maʻi maʻamau.Ua hōʻoia ʻia ka loiloi correlation multivariate ʻo ka pae D-Dimer he mea wānana kūʻokoʻa o nā hanana thrombotic a i ʻole cardiovascular i ka wā anticoagulation.

• No nā poʻe maʻi me ka atrial fibrillation (AF), hiki iā D-Dimer ke wānana i nā hanana thrombotic a me nā hanana cardiovascular i ka anticoagulation waha.He 269 mau mea maʻi me ka atrial fibrillation i ukali ʻia ma kahi o 2 mau makahiki i hōʻike ʻia i ka wā o ka anticoagulation waha, ma kahi o 23% o nā mea maʻi me INR i hōʻea i ka pahuhopu i hōʻike i nā pae D-Dimer maʻamau, aʻo nā mea maʻi me nā pae D-Dimer abnormal i hoʻomohala ʻia Nā pilikia o ka thrombotic. nā hanana a me nā hanana cardiovascular comorbid he 15.8 a me 7.64 manawa, kēlā me kēia, o nā maʻi me nā pae D-Dimer maʻamau.

• No kēia mau maʻi kūikawā a i ʻole nā ​​maʻi maʻi, ʻike pinepine ʻia ka D-Dimer kiʻekiʻe a i ʻole ka maikaʻi mau loa i ka maikaʻi ʻole a i ʻole ka piʻi ʻana o ka maʻi.

4. Ka hoʻohana ʻana o D-Dimer i ka lāʻau anticoagulation waha:

• Hoʻoholo ʻo D-Dimer i ka lōʻihi o ka anticoagulation waha: ʻO ka lōʻihi maikaʻi loa o ka anticoagulation no nā poʻe maʻi me VTE a i ʻole thrombus ʻē aʻe ʻaʻole maopopo.No ka NOAC a i ʻole VKA, ʻōlelo nā alakaʻi pili honua e hoʻoholo i ka anticoagulation lōʻihi e like me ka pilikia o ke koko i ke kolu o ka mahina o ka anticoagulation therapy, a hiki iā D-Dimer ke hāʻawi i ka ʻike pilikino no kēia.

• Alakaʻi ʻo D-Dimer i ka hoʻoponopono ʻana i ka ikaika anticoagulant waha: ʻO Warfarin a me nā anticoagulants waha hou nā anticoagulants waha maʻamau i hoʻohana ʻia i ka hoʻomaʻamaʻa lapaʻau, ʻo ia mau mea ʻelua e hiki ke hoʻemi i ke kiʻekiʻe o D-Dimer.a me ka hoʻoulu ʻana o ka ʻōnaehana fibrinolytic, no laila e hōʻemi ʻole i ka pae o D-Dimer.Hōʻike nā hopena hoʻokolohua ʻo D-Dimer-guided anticoagulation i nā poʻe maʻi e hōʻemi pono i ka hopena o nā hanana ʻino.