Diagnostik der disseminierten intravasalen Gerinnung: Aussagekraft von löslichem Fibrin, D-Dimeren und Fibrin(ogen)-Spaltprodukten

Abstract

The validity of the fibrin(ogen) derivatives 'soluble fibrin, D-dimers and fibrin(ogen) degradation products' was compared with other parameters in early and sensitive diagnosing of disseminated intravascular coagulation (DIC). In a clinical study 900 patients' samples from separate, defined groups were examined, including course observations of intensive care patients (n = 38) and patients with acute pancreatitis. The fibrin(ogen) derivatives correlated very well with the degree of blood coagulation disturbances: in particular, D-dimers and soluble fibrin proved to be more sensitive in early diagnosis of DIC than other parameters. The SF-PS-turbidimetry demonstrated a good validity and practicality in the quantitative determination of soluble fibrin, but a suitable analyzer is essential. Determination of D-dimers is preferable to that of fibrin(ogen) degradation products (both in the latex-agglutination test) because of the better sensitivity and practicality; even more sensitive results were provided by the D-dimer-ELISA, which is, however, not practical in acute diagnostics. The decrease in protein C was at least equally sensitive as the antithrombin III-levels in indicating the consumption of the hemostatic potential. The decrease of thrombocyte counts and fibrinogen levels could first be detected in a later stage of DIC. In conclusion, D-dimers and soluble fibrin can improve the DIC diagnostics, making them more reliable; additionally, antithrombin III and possibly protein C deserve further consideration, although the fibrin(ogen) derivatives are apparently of greater importance.

D-Dimer, Thrombin-Antithrombin III-Komplex (TAT) und Prothrombinfragment 1+2 (PTF)

“…20 min sind über den TAT-Komplex kurzfristige Ände-rungen der systemischen Gerinnungsaktivierung erfaßbar. Das D-Dimer gibt als einziger Parameter Aufschluß sowohl über die Thrombinbildung als auch über eine (Hyper-)Fibrinolyse [6,7,21,27]. Bei der Diagnosestellung einer DIC werden dem TAT-Komplex eine Sensitivität von 97% und dem D-Dimer eine von 100% bescheinigt [4].…”