The presence of XLFDP in plasma, a consequence of the balance between fibrin generation and dissolution, is an indirect index of the presence of fibrin and raised levels accompany intravascular thrombosis. The potential of an enzyme immunoassay (EIA) for XLFDP, using the monoclonal antibody DD-3B6/22 was evaluated in 104 patients with suspected DVT receiving lower limb venography. Using a reference level of 400 ng/ml of XLFDP, all patients with a positive venogram had elevated levels (sensitivity 100%), although levels were also elevated due to causes other than DVT in some patients with negative venograms (specificity 52%). Higher elevations of XLFDP occurred in proximal than in calf DVT.A second study of another 48 patients receiving venography for suspected DVT confirmed the sensitivity of EIA while the complementary latex "Dimertest", also based upon DD-3B6/22, was positive in 19 and negative in 3 patients with confirmed DVT. In an ongoing study, 130 patients have been followed after abdominal operations with 125I-fibrinogren leg scanning and venography when appropriate. Levels of XLDFP (EIA) were elevated in all patients developing thrombosis. Latex assays were positive in 42/48 patients with positive leg scans. While elevated levels of XLDFP do not specifically define the location or even the presence of a thrombus they reliably indicate the possibility of thrombosis in patients without antecedent medical or surgical illnesses. In complicated surgical patients,an arbitrary cut-off of 1000 ng/ml is more appropriate for screening for the possibility of DVT. A positive latex test is also suggestive, although it is negative in some patients with calf thrombi. Measurements of XLFDP, with high sensitivity but moderate specificity, are potentially valuable in selecting patients for invasive investigations such as venography, and combinations with other noninvasive screening tests for require evaluation
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