help with pt with elevated D-dimer please

[Guest guest]

Ok

folks, I need to tap into the incredible collective wisdom of this group.

I

have a 59yo healthy never smoker G4P4 WF with homozygous factor V Leiden

mutation and MTHFR mutation who has had no hx of thrombosis; takes ASA 325 and

is not on ERT/HRT. Checked annual D-dimer as recommended by heme, and

this time it was elevated at 610 (nl 100-400) and a week later (today) was 560.

Heme said to look for a clot as this is not nl for these pts. Pt has no

sxs, nl hx of recent trauma/extended travel/prolonged sitting, no recent surgery,

no known malignancy, and is very active. She had nl SaO2 at home (husband

has finger model) and in my office, even with ambulating. With detailed

questioning, was having intermittent nocturnal R upper arm discomfort, so

checked sono, and was nl from ear to R wrist. Normal exam, including no

bulging of vessels, no edema, no discomfort (even in R arm), etc.

Any

idea how long D-dimer stays elevated?

What

else should I look for?

Not

finding the answers I need from UpToDate…

Waiting

to feel enlightened (and humbled) with your suggestions…

THANKS!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com