Serum crosslinked fibrin (XDP) and fibrinogen/fibrin degradation products (FDP) in disorders associated with activation of the coagulation or fibrinolytic systems

Abstract

Soluble crosslinked fibrin derivatives (XDP) in serum were determined by enzyme immunoassay utilizing monoclonal antibodies and compared with serum fibrinogen/fibrin degradation products (FDP) assayed by conventional techniques. In healthy subjects and patients with miscellaneous disorders not usually associated with activation of the haemostasis mechanism, mean XDP levels were 45 and 70 ng/ml respectively. However, elevated levels of XDP occurred in conditions commonly associated with intravascular and possibly extravascular activation of the coagulation system. Markedly raised mean XDP values (677-6900 ng/ml) occurred in treated pulmonary embolism, disseminated neoplasia, severe inflammatory disorders and complicated postoperative states, and lesser but significant elevation (mean 150-400 ng/ml) in treated venous thrombosis, uneventful postsurgical states, localized neoplasia, liver disease and symptomatic arterial disease. Levels during initial streptokinase therapy (mean 24 000 ng/ml) fell tenfold as treatment was continued. The degree of XDP elevation over normal values was significantly higher than that of FDP in conditions with a propensity for venous thrombosis (post-operative states, disseminated neoplasia and inflammatory diseases) than in liver disease, localized neoplasia or patients receiving heparin therapy for venous thromboembolism.

Role of ELISA D‐dimer test in patients with unstable angina pectoris presenting at the emergency department with a normal electrocardiogram

“…Several studies have shown that the likelihood of myocardial infarction is higher in patients with high levels of biochemical markers of thrombus formation, namely, fibrinogen, prothrombin fragment [1,2], thrombin-antithrombin complex, and fibrinopeptide [2][3][4]. D-dimer is the primary degradation product of cross-linked fibrin and therefore serves as a direct marker of ongoing coagulation with fibrinolysis [5]. It has also been shown to correlate well with subsequent coronary artery events [6].…”

Determinants of ELISA D‐dimer sensitivity for unstable angina pectoris as defined by coronary catheterization

“…In addition, in one study, there was an approximately 5-fold increase in Ddimer level in patients with UAP and acute myocardial infarction. During thrombolytic therapy, fibrinogen levels dropped to 12-20% of their original values, and D-dimer plasma concentrations rose 70-to 130-fold [4,8]. High D-dimer levels may reflect a systemic prothrombotic state and, possibly, focal vessel-wallrelated fibrin formation with unstable atherosclerotic plaque activity [9].…”

“…Thrombogenesis is the final process whereby the exposed tissue factor triggers the coagulation, and the freshly formed clot fills the coronary artery lumen [1][2][3]. D-dimer is the primary degradation product of crosslinked fibrin and therefore serves as a direct marker of ongoing fibrinolysis [4]. Although the D-dimer level has been shown to correlate well with subsequent coronary artery events [5], its reported sensitivity varies so widely that its diagnostic utility is questionable [6,7].…”

“…The variability in assay sensitivity may be attributable to several factors. Most studies evaluated the assay method at a single discriminate level [4,8,9]. At least 5 different assay methods (enzyme-linked immunosorbent assay [ELISA], latex agglutination, whole-blood agglutination, immunofiltration, membrane ELISA) have been used to measure D-dimer level, although ELISA is considered the gold standard [10,11].…”

Evaluation of fibrinolytic therapy by measuring cross-linked fibrin derivatives and plasmin-.ALPHA.2-plasmin inhibitor complex in plasma.

“…Recently, it has become possible to measure specifically cross-linked fibrin derivatives (XDP) by using monoclonal antibodies which react with cross-linked fibrin degradation products including Ddimer (Elms et al , 1986Rylatt et al 1983;Whitaker et al 1984). Elevated plasma (or serum) XDP levels have been observed in patients with thromboembolic disorders, disseminated intravascular coagulation and after streptokinase infusion (Whitaker et al 1984;Hunt et al 1985;Elms et al 1986; Lew et al 1986). Furthermore, sensitive enzyme-linked immunosorbent assays (ELISA) of plasmin-a2PI complex have been developed (Harpel 1981;Mimuro et al 1987).…”