D-Dimer in Local Thrombolytic Therapy with Low Doses of Recombinant Human Tissue-Type Plasminogen Activator (rt-PA) in Patients with Peripheral Arterial Occlusive Disease

Abstract

SummaryThe generation of D-dimer was studied in the course of local thrombolytic therapy of peripheral arterial occlusions with low doses of recombinant human tissue-type plasminogen activator (rt-PA) in 7 patients. Intermittent local application of rt-PA resulted in a marked increase in D-dimer exceeding values usually seen after intravenous application of manifold higher doses used in myocardial infarction. The increase in D-dimer was related to the estimated thrombus size (length of the occlusion) and the total dose of rt-PA applied. During local rt-PA infusion 6 of 7 patients maintained plasminogen activator inhibitor capacity (PAI-cap) between 34% and 79% of their corresponding pre-treatment levels; detectable levels of PAI-cap in circulating blood during the procedure did not interfere with the success of therapy.

Hyperthermic Fibrinolysis with rt-PA: In Vitro Results

“…Concentrations of D-dimer therefore represent a specific fibrin degradation product and thus are elevated in patients suffering from thromboembolic disorders [17]. The determination of D-dimer concentration is a valid measure for quantifying the efficacy of fibrinolytic therapy [17].…”

Fibrinogen, D-Dimer and Thrombin-Antithrombin Complexes in a Random Population Sample: Relationships with Other Cardiovascular Risk Factors

“…Cross-linking of fibrin occurs when factor XIIIa causes y-chains to bond and subsequent plasmin lysis of cross-linked fibrin releases D-Dimer complexes in varying amounts depending on the extent of lysis of the fibrin polymers. D-Dimer has been studied in patients with various thrombotic disorders such as peripheral arterial disease (25), acute myocardial infarction (26) and coronary heart disease (27) and its high concentration is considered a laboratory marker of thrombosis and activation of fibrinolysis. Since several recent reports indicate that D-Dimer is a good marker in deep venous thrombosis, in future it may well be used in deep venous thrombosis diagnosis (28)(29)(30).…”

Thrombolytic Therapy in Acute Lower Limb Ischemia

“…Although the global coagulation tests remain unaffected by lower rt-PA dos age (< 20 mg total dose), a decrease in α 2 -antiplasmin and a rise in D-dimer indicated a low systemic effect during IAT. 39,40 Uncontrolled studies with the pulse-spray technique reported average times of 65 to 93 minutes for complete lysis of deep-seated femoral/crural vessels and arterial bypasses. 41,42 In a large, nonrandomized study, successful thrombolysis was observed in 95% of patients with a mean lysis time of 96 minutes.…”

“…Even the lowdose rt-PA regimen results in a minimal systemic effect that cannot be ruled out by normal global hemostatic tests. 39,40 Therefore, patients with atheromatous lesions in the carotid artery or intracardial thrombi are at high risk of suffering cerebral infarction even under low-dose regimens for IAT. Cerebral infarct incidences up to 2% are reported in IAT.…”