Plasma Measurement of D-Dimer as Diagnostic Aid in Suspected Venous Thromboembolism: An Overview

Bounameaux, Henri; Moerloose, P de; Perrier, Arnaud; Reber, Guido

doi:10.1055/s-0038-1642375

Cited by 374 publications

(207 citation statements)

References 34 publications

(28 reference statements)

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“…Results of thrombotic marker assays in the patients showed that D. Dimer levels 19 were increased sevenfold as compared with the controls, whereas the levels of TAT and F 1+2 were normal in controls and in patients. Elevation of D. Dimer levels denotes activation of ®brin formation inside and even outside the vascular system and therefore indicates that clinical or subclinical thrombosis has occurred despite the administration of prophylactic anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 99%

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

et al. 1997

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Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of ®brinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the ®ve other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased signi®cantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no signi®cant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of ®brinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI 1 ) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-®ve per cent of patients (prophylactically anticoagulated or not) had very high levels of ®brin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombinantithrombin complexes and prothrombin fragments 1+2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of ®brinolytic potential suggests a proposal for the patients an inde®nite antithrombotic treatment at curative doses.

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Section: Discussionmentioning

confidence: 99%

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

et al. 1997

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“…We believe the diagnosis of UAP at admission to the ED should be based on clinical factors such as history, physical examination, and electrocardiography, and not on blood markers. Moreover, the generally low specificity of the available D-dimer assays (ELISA, latex agglutination assay, turbidometric immunoassays) and their wide variations in sensitivity [16][17][18] preclude their use as a diagnostic tool [16,[19][20][21][22]. Because of the low interassay correlation [21,22] and the lack of a D-dimer reference standard, we used the ELISA, which is currently considered the gold-standard methodology.…”

Section: Discussionmentioning

confidence: 99%

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

Shitrit¹,

Shitrit²,

Rudensky³

et al. 2004

American J Hematol

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Patients with unstable angina pectoris and acute myocardial infarction have higher than normal D-dimer levels. The aim of the study was to determine the value of the D-dimer test in patients with unstable angina pectoris and a normal electrocardiogram on presentation at the emergency department. The study sample included 81 patients who met these criteria. Blood samples collected at admission were subjected to ELISA D-dimer. Findings were correlated with coronary risk factors, use of cardiac medications, blood levels of acute phase reactants (fibrinogen and C-reactive protein), cardiac enzymes levels, length of hospital stay, and catheterization findings. ELISA D-dimer levels were statistically significantly correlated with cardiac risk factors, namely male sex, older age, smoking, and hypertension (r = 0.25, P = 0.02; r = 0.43, P = 0.0001; r = 0.26, P = 0.03; r = 0.35, P = 0.002, respectively), in addition to use of cardiac medications (beta blockers, aspirin, nitrates), levels of acute phase reactants, length of stay, and catheterization findings. On multivariate analysis, only D-dimer level, age, and sex were predictors of length of stay (P = 0.018). The study suggests that D-dimer levels at admission to the emergency department may serve as an additional tool to predict the magnitude of unstable angina pectoris in patients with a normal electrocardiogram. Am.

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“…However, it could be a valuable additional test to exclude thrombo in the first period of suspected DVT as v/ell as in recur rent signs of DVT. Further research, such as management studies in patients clinically sus pected of DVT, has to be performed [127]. Also, more rapid D D tests (more sensitive latex assays or more rapid E LISA 's) have to be developed [128].…”

Section: Npv (%)mentioning

confidence: 99%

Diagnosis of deep vein thrombosis, an overview

Janssen

Wollersheim

Nováková

et al. 1996

The Netherlands Journal of Medicine

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A bstractBecause clinical signs and symptoms are unreliable the diagnosis of deep vein thrombosis (DVT) should be objectified. Advantages and disadvantages of contrast venography, plethysmography, ultrasound techniques, fibrino gen leg scanning, computer-assisted tomography, magnetic resonance imaging and blood tests are discussed. In patients with a first event of suspected DVT non-invasive methods like serial plethysmography or ultrasound testing are sensitive and specific enough to make a treatment decision. It is safe to withhold anticoagulants if the test remains normal within 1 week. In patients with suspected recurrent DVT new non-invasive techniques are being tested, but up to now the definitive objective diagnostic test continues to be contrast venography. In first period as well as in recurrent DVT D-Dimer testing could be an additional test to exclude active thromboembolism.

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Plasma Measurement of D-Dimer as Diagnostic Aid in Suspected Venous Thromboembolism: An Overview

Cited by 374 publications

References 34 publications

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

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

Diagnosis of deep vein thrombosis, an overview

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