Diagnostic possibilities of specific fibrin(ogen) degradation products in relation to venous thromboembolism

Blood Coagul Fibrinolysis. 2013 Apr;24(3):297-304. doi: 10.1097/MBC.0b013e32835bdcbd.

Abstract

The exclusion of deep venous thrombosis (DVT) in the elderly is hampered by low specificity in clinical decision of D-dimer assays in older patients. To reduce false-positive results, we evaluated specific fibrin(ogen) degradation product assays for their contribution in the diagnosis of DVT. In a post-hoc study with outpatients suspected for DVT, we evaluated the elastase-specific fibrinogen (fibrinogen elastase degradation product, FgEDP) and D-E-specific fibrin (fibrin degradation product, FbDP) degradation product assays in relation to DVT. Results were combined with five D-dimer assays as ratio, with a specific focus on age-dependency. In 437 patients (DVT prevalence 39%), FgEDP correlated with D-dimer in DVT-negative patients (P<0.001), but not in DVT-positive patients (P > 0.55). FbDP results correlated with D-dimer in both groups (P<0.001). The values of the area under the curve of the receiver operating characteristic curve for both assays were lower than D-dimer. Using the ratios, only in the fourth age quartile D-dimer/FgEDP ratios had diagnostic value with lower number needed to test (1.8-12.7) as compared to D-dimer less than 500 μg/l alone (5.4-102). The D-dimer/FbDP ratios in DVT-negative elderly patients increased to a plateau by increasing D-dimer. In DVT-positive patients, these ratios were near constant for increasing values of D-dimer. In elderly patients, the D-dimer/FgEDP ratios may improve the number of patients in whom DVT could be excluded. The D-dimer/FbDP ratios showed differences in composition of fibrin degradation products between DVT-negative and DVT-positive patients and between young and old DVT-negative patients.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • False Positive Reactions
  • Female
  • Fibrin / metabolism*
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Fibrinogen / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Proteolysis
  • ROC Curve
  • Venous Thrombosis / blood*
  • Venous Thrombosis / diagnosis*

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Fibrin
  • Fibrinogen