Measurement of Crosslinked Fibrin Derivatives -Use in the Diagnosis of Venous Thrombosis

Abstract

SummaryThe measurement of crosslinked fibrin derivatives in plasma has received evaluation as a screening test in the diagnosis of venous thrombosis. Plasma samples were taken from 104 patients undergoing venography because of clinical suspicion of lower limb venous thrombosis. The samples were assayed using a monoclonal antibody identifying an epitope on D dimer and larger crosslinked fibrin derivatives in an enzyme immunoassay. 100% of patients with positive venograms had elevated levels of these molecules. While a percentage of patients with negative venograms also had increased levels, alternative clinical explanations were apparent in most. A normal D dimer value excludes the diagnosis of venous thrombosis, while an increased value supports it. The measurement of crosslinked fibrin derivatives in plasma may play a role in the selection of patients for venography.

Diagnosis of deep vein thrombosis, an overview

“…If adequately performed, CV outlines the entire deep venous system of the leg, including the common iliac vein and inferior caval vein. In this way it establishes Table 1 Positive predictive value of several "classical" signs of DVT, when the result of physical examination is compared to venography 1990 [12] (%) Spontaneous pain 44 38 61 63 Palpatory pain 49 22 68 65 Increased circumference 40 63 61 Oedema 54 32 45 32 62 72 Warmth 50 71 68 32 Erythema 55 13 65 28 Homans' sign 58 72 15 62 21 Fever 17 68 59 Venous dilatation 60 79 75 17 93 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] i l l the presence, precise location, extent and occlusiveness of venous thrombi. O f a number of methods for performing CV, ascending venography according to the technique of Rabinov [21] and Thomas [31] is most com monly used.…”

“…The method is 112 Medicine 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] based on measurements of changes in blood vol ume in the leg produced by temporary venous obstruction. During a period of venous outflow occlusion by a thigh cuff the increase in volume is measured.…”

“…Second, isolated thrombi in the iliac vein and in the superficial femoral vein within the adductor canal are difficult to detect. 4H (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] Criteria associated with DVT are respectively absence of flow, continuous flow without phasicity with respiration, and absence or diminished augmentation of flow with distal compression or proximal decompression. The results for proximal DVT are presented in Table 2.…”

“…O f these markers D-Dimer (DD) has been studied most extensively as a potential aid in the diagnostic management of DVT. Table 3 gives a summary of studies in which plasma mea surements of D D (ELISA) were performed in the diagnosis of DVT [115][116][117][118][119][120][121]. The results of these investigations show that a low concentration of plasma D D measured by the ELISA technique might be used to rule out venous thrombosis in clinically suspected patients: its sensitivity is 92- Table 3 Summary of studies in which plasma measurements of D-Dimer (ELISA ) were performed in the diagnosis of DV T…”

“…The disad vantages of this procedure have led to the devel opment of a wide array of less invasive tests like Medicine 48 (1996) [109][110][111][112][113][114][115][116][117][118][119][120][121] impedance-and strain-gauge plethysmography, Doppler ultrasound investigations, ultrasonogra phy, duplex scanning, scintigraphic methods and blood tests to confirm or exclude venous throm bosis. In this paper the experience with these tests in two different situations is discussed: (1) patients showing signs and symptoms of DVT for the first time, (2) patients with previous DVT showing recurrence of signs and symptoms in the same limb.…”