D-Dimer and Thrombin/Antithrombin III Complex – Diagnostic Tools in Deep Venous Thrombosis?

Tengborn, Lilian; Palmblad, Suzanne; Wojciechowski, J; Peterson, Lars-Erik; Stigendal, Lennart

doi:10.1159/000217125

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…However, latex methods are subjective, often difficult to read and, as demonstrated in Table 1, most assays have a suboptimal Sens and NPV, which cannot be changed by adapting the cut-off values. [15][16][17][18][19][20][21][22][23][24][25][26][27] For this reason, most of these assays cannot be used in the diagnostic approach of patients suspected of DVT.…”

Section: Latex Dd For Exclusion Of Dvtmentioning

confidence: 99%

Rapid D-Dimer Assays to Exclude Deep Venous Thrombosis and Pulmonary Embolism: Current Status and New Developments

Janssen

Wollersheim²,

Verbruggen³

et al. 1998

Semin Thromb Hemost

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Studies measuring the fibrin degradation product D-Dimer (DD) using enzyme-linked immunosorbent assays (ELISA) in patients suspected of deep venous thrombosis (DVT) or pulmonary embolism (PE) suggest that it is possible to exclude DVT/PE when the DD level is below a certain cut-off value. However, ELISA methods are time-consuming, bare high costs, and are only available in experienced laboratories. For this reason several rapid and less costly DD assays have been recently developed. This article reviews the current literature about rapid latex and ELISA DD assays in the diagnostic approach of DVT and PE. Two new latex assays seem suitable in clinical practice. The most extensively studied assay is the so-called SimpliRed DD, an autologous red cell agglutination test that can be performed on fresh whole blood. For DVT a sensitivity (Sens) and a negative predictive value (NPV) of 89-100% and 95-100%, respectively, have been reported, for PE 94-100% and 98-100%, respectively. The second test, Tinaquant, is a quantitative latex assay. Sens and NPV for DVT of 99% and 93% have been reported in one study. Two rapid ELISA assays have been investigated. The most extensively studied is the VIDAS DD assay, a fully automated quantitative ELISA method. Sens and NPV of 94-100% and 92-100% for DVT and both 100% for PE have been reported. For the other rapid ELISA, Instant IA DD, Sens and NPV of 92-93% and 76-77% have been reported for DVT. The last one is a qualitative assay giving only positive or negative results. These results show that low concentrations of plasma DD measured by especially SimpliRed or VIDAS DD, might be used to reliably rule out DVT or PE in clinically suspected patients. Tinaquant seems promising and has to be evaluated further. As for standard ELISA, increased DD concentrations are of no use because of the low specificity of the assays. Future studies should assess the clinical usefulness of both assays in management trials under routine conditions, in the frame of clinical decision-making diagnostic processes to prove that withholding further noninvasive testing and/or anticoagulants in patients with a low or negative DD is safe. Strategies to identify patients with false-negative results should be developed.

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Section: Latex Dd For Exclusion Of Dvtmentioning

confidence: 99%

Rapid D-Dimer Assays to Exclude Deep Venous Thrombosis and Pulmonary Embolism: Current Status and New Developments

Janssen

Wollersheim²,

Verbruggen³

et al. 1998

Semin Thromb Hemost

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“…1,6 However, D-Dimer results can be false positive in a large proportion of patients with cancer. 2,3 In this study, we compared the concentration of D-Dimer with other signs of venous thromboembolism from medical history, physical examination, and Doppler ultrasonography. Based on numerous reports, Doppler ultrasonography is the most helpful imaging technique that can be used for detecting thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, high values of D-dimer are not sufficient for diagnosis of VTE due low specificity and positive predictive value. 2 False positive results, i.e., elevated D-dimer values in patients without VTE, are often found in patients with cancer, infections, myocardial infraction, stable and unstable angina pectoris, thrombotic superficial phlebitis, rheumatoid arthritis, septicemia, pregnancy, after trauma or surgery, and in elderly patients. 3 In this study, we included 150 patients treated surgically for active cancers of the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy

et al. 2017

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The concentration of D-dimer is often elevated in patients with active cancer, but is not a sufficient criterion for diagnosis of VTE. The concentration of D-dimer before surgery does not determine the risk of postoperative thromboembolic complications. This is undoubtedly related to the widespread use of effective thromboprophylaxis. According to the literature, ultrasound is the optimum method for detection of VTE in surgically treated cancer patients. The effect of cancer stage on the value of D-dimer is revealed only when the cut-off point in this group is 1440 ng/ml, instead of 500 ng/ml which is used for the general population.

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“…Therefore, each D-dimer assay must be used with its own cut-off value to classify a result correctly as D-dimer-negative or D-dimer-positive [17]. As the performance of D-dimer assays is also not optimal, some other markers of coagulation activation are considered to be useful for the diagnosis of thrombosis [5][6][7][8]. Plasma fibrin monomer can be determined by immunological-based methods, the haemagglutination assay and a chromogenic assay.…”

Section: Discussionmentioning

confidence: 99%

“…Several laboratory parameters other than D-dimer in DVT have been studied. Fragment F1þ2, thrombin-antithrombin complex and fibrin monomer diagnostic measurements range from inferior to equally effective as D-dimer [5][6][7][8]. Some studies have suggested that fibrin monomer has a similar efficacy to the D-dimer test for the exclusion diagnosis of venous thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Excluding deep venous thrombosis in symptomatic outpatients: is fibrin monomer aid to D-dimer analysis?

Dopsaj

Bogavac-Stanojević

Vasić

et al. 2009

Blood Coagulation &Amp; Fibrinolysis

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Many studies have investigated the clinical accuracy of the D-dimer test in combination with pretest probability score for deep venous thrombosis (DVT) exclusion. However, few have evaluated its potential when combined with additional markers such as fibrin monomer. The aim of this study was to test the incremental usefulness of fibrin monomer for DVT screening in a bi-marker approach. This was achieved by adding the fibrin monomer to logistic models that included different D-dimer tests. Plasma concentrations of D-dimer and fibrin monomer were measured in 96 outpatients suspected of having DVT and in 76 patients selected from the total patient group according to pretest probability score (termed the DVT-unlikely group). We constructed receiver operating characteristic curves for three different D-dimer assays. Predictive probabilities from different logistic regression models and pair-wise comparisons of the areas under the receiver operating characteristic curve (AUCs) were calculated without and with fibrin monomer included in the models. For all three D-dimer assays, the AUCs were higher in the DVT-unlikely group compared with AUCs in the total patient group [but the differences were without statistical significance (P > 0.05)]. The calculated fibrin monomer AUCs (0.724 in the total patient group and 0.683 in the DVT-unlikely group) were lower than the D-dimer tests' AUCs. The AUCs obtained from logistic regression models that included the three D-dimer tests in the total patient group and the DVT-unlikely group were significantly increased when fibrin monomer was included in the model to such an extent that the AUCs for one of them indicated outstanding discriminative abilities. Simultaneous D-dimer and fibrin monomer determination provides a more valuable approximation for DVT exclusion compared with just D-dimer analysis. Bearing in mind that the fibrin monomer assay is now both more practical and more suited for routine clinical use, fibrin monomer determination could be a more commonly used parameter together with D-dimer and pretest probability score for DVT diagnosis in the future.

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D-Dimer and Thrombin/Antithrombin III Complex – Diagnostic Tools in Deep Venous Thrombosis?

Cited by 9 publications

References 16 publications

Rapid D-Dimer Assays to Exclude Deep Venous Thrombosis and Pulmonary Embolism: Current Status and New Developments

Rapid D-Dimer Assays to Exclude Deep Venous Thrombosis and Pulmonary Embolism: Current Status and New Developments

The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy

Excluding deep venous thrombosis in symptomatic outpatients: is fibrin monomer aid to D-dimer analysis?

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