D-Dimer Determination to Assess Regression of Deep Venous Thrombosis

Abstract

SummaryA number of studies evaluating deep venous thrombosis (DVT) have demonstrated that plasma levels of thrombotic and fibrinolytic parameters change during treatment, but the relationship between thrombus regression and evolution of these markers remains unknown. The objective of the present study was to correlate levels of D-Dimer (DD) with thrombus regression as assessed by duplex scanning.From 44 patients treated for acute DVT, DD were determined at diagnosis and at the end of initial heparin therapy of at least 5 days. Thrombus regression was measured by repeated duplex scanning at diagnosis and after 1 and 3 months.DD significantly decreased during heparin treatment as compared with values at presentation. DD levels were significantly higher in the group of patients without normalization of the DVT after 3 months (p = 0.003). A ninefold excess tendency was seen for DD levels > 1200 ng/ml at the end of initial treatment to be associated with poor resolution of the DVT [odds ratio 9.0, 0.95 confidence interval (CI) 2.3-35.4]. When the patients with an established malignancy were excluded, the differences were even more significant (p = 0.0004 for DD levels after initial treatment and an odds ratio of 17.5, 0.95 CI 3.3-92.5).These results suggest that increased DD levels after the initial phase of treatment are related to poor resolution of DVT after 3 months. These findings contribute to further insight into the process of thrombus regression. Furthermore high DD levels might help to identify the patients with a poor prognosis and could be useful to judge the efficacy of anticoagulant treatment.

The diagnostic yield of D-Dimer in relation to time from symptom onset in patients evaluated for venous thromboembolism in the emergency medicine department

“…Eighty-seven patients had DVT and in them, it was clearly seen that D-Dimer concentrations were at their highest concentration on the second day from the diagnosis [5]. The time course analysis of D-Dimer has been shown to be a marker of thrombus resolution and high D-Dimer concentrations during the course of treatment and might identify patients with a non-resolving or slow resolving thrombus [6][7][8][9][10]. Therefore it is conceivable that the concentration of D-Dimer will follow an expected and accurate time course.…”

Myeloid cell tissue factor does not contribute to venous thrombogenesis in an electrolytic injury model

“…D-dimer levels are elevated in initial thrombus formation [41] and serve as an indicator of fibrinolysis [42]. In this study D-dimer levels were used as a supporting indicator of thrombus development and resolution.…”

“…In this study D-dimer levels were used as a supporting indicator of thrombus development and resolution. In opposition to TF, which is important in thrombus initiation [4-6], D-dimer plasma levels increase at later time points in thrombosis, during fibrinolysis [42] and thrombus resolution. We showed that, both the LysMCre positive and LysMCre negative mice showed a peak in D-dimer levels at day 2 post thrombosis, which decreased to baseline levels by day 6, despite a large thrombus burden.…”

The diagnosis of deep vein thrombosis in symptomatic outpatients and the potential for clinical assessment and D‐dimer assays to reduce the need for diagnostic imaging

“…While this is highly unlikely to affect the interpretation of imaging studies, it may affect the interpretation of D‐dimer assays. Several studies have shown a fall in D‐dimer levels following anticoagulation with heparins (Speiser et al , 1990; Janssen et al , 1997b; Stricker et al , 1999). Stricker et al (1999) demonstrated a significant fall in D‐dimer values in patients that were serially tested after commencing anticoagulation with heparin or low molecular weight heparin for VTE.…”

“…Moreover, the D‐dimer level recorded on any 1 d in patients on nadroparin depended on the time of sampling with lower levels detected at times of peak heparin activity (Stricker et al , 1999). In a study of 44 patients treated with heparin for at least 5 d, changes in D‐dimer levels were observed that would have altered the interpretation of the assay performed as a screening test for excluding the diagnosis of VTE (Janssen et al , 1997b). There are few data on the effect of a single dose of heparin on the interpretation of D‐dimer assays for exclusion of a diagnosis of DVT.…”