Cross-linked fibrin degradation products (XL-FDP) as marker of early rethrombosis in percutaneous transluminal angioplasty.
The thrombotic response to percutaneous transluminal angioplasty (PTA) was investigated in 31 patients treated for 1-10 cm femoropopliteal (n = 28) and tibial (n = 3) artery obstructions by measurement of cross-linked fibrin degradation products (XL-FDP) in peripheral blood samples drawn before and 30 min after PTA. XL-FDP increased from 400 +/- 147 ng/ml to 700 +/- 445 ng/ml (median +/- S.E., p = 0.0005). XL-FDP rose from 320 +/- 110 ng/ml to 540 +/- 102 ng/ml in 23 patients, whose ankle/brachial systolic blood pressure index (ABI) increased > 0.15 after PTA, whereas XL-FDP increased from 850 +/- 450 ng/ml to 2620 +/- 1472 ng/ml in eight patients, who failed to increase ABI in spite of preceding recanalisation. XL-FDP increased by more than 1000 ng/ml in 1/23 (4.3%) patients with uncomplicated PTA and in 6/8 (75%) patients with haemodynamic failure (p = 0.0005). Using a XL-FDP increase of 1000 ng/ml as cut-off, estimates of positive and negative predictive values (95% confidence limits) for early failure of PTA were 85.7% (42.1-99.6%) and 91.7% (73.0-99.0%), respectively. We conclude from this pilot study that femorotibial PTA produces a hypercoagulable state which may result in failure of early patency due to rethrombosis. We suggest for the first time XL-FDP as a marker of early rethrombosis in PTA, and report a sequential XL-FDP assay which may be useful for identification of high-risk patients requiring thrombolytic therapy after PTA for maintenance of early vascular patency.
Jørgensen
B
B
Department of Vascular Surgery Unit, Skejby Hospital, University of Aarhus, Denmark.
Nielsen
J D
JD
Nørgård
J
J
Helligsø
P
P
Baekgaard
N
N
Egeblad
M
M
D000368:Aged; D000800:Angioplasty, Balloon; D015415:Biomarkers / Q000097:blood; D005260:Female; D005263:Femoral Artery; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011150:Popliteal Artery; D011237:Predictive Value of Tests; D012008:Recurrence; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products