D-dimers, thrombin-antithrombin complexes, and risk factors for thromboembolism in hospitalized patient.
BACKGROUND
There is lack of data about the correlation between hemostatic markers and the clinical and biological risk factors (RFs) for venous thromboembolism (VTE) in medical inpatients without suspicion of acute VTE.


METHODS
To evaluate the coagulation activation status in patients with current known RFs for VTE, the authors measured 2 markers of hypercoagulability, thrombin antithrombin (TAT) complexes and D-dimers, at day 1 in 165 patients hospitalized in internal medicine wards without suspected acute VTE. All known RFs for VTE were systematically assessed at admission and classified in a chronological way as permanent or transient.


RESULTS
Surprisingly, TAT values followed a multimodal distribution. D-dimers showed a normal distribution after a logarithmic transformation (P = .34, Shapiro-Wilk test). Interestingly, a significant progression in D-dimer levels was found according to the chronological classification of RFs. D-dimer variations on multivariate analysis (not applicable for TAT because of the multimodal distribution) correlated independently with a recent inability to walk and an increase in C reactive protein level more than 10 mg/L.


CONCLUSIONS
(a) this study is the first to describe the variations of hypercoagulability markers according to a systematic screening of RFs for VTE in inpatients without suspicion of acute VTE, (b) TAT appeared as a less relevant marker of hypercoagulability than D-dimers in internal medicine inpatients, (d) the chronological classification of RFs identified clearly groups at risk for the prethrombotic state, and (d) an increased hypercoagulability state was demonstrated in patients with an association between a recent immobility and increased inflammatory markers.
Pottier
Pierre
P
Department of Internal Medicine, Nantes University-Hospital Centre, Nantes, France. pierre.pottier@univ-nantes.fr
Fouassier
Marc
M
Hardouin
Jean-Benoit
JB
Volteau
Christelle
C
Planchon
Bernard
B
D000990:Antithrombin III; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006487:Hemostasis; D006801:Humans; D007249:Inflammation / Q000097:blood; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016011:Normal Distribution; D010291:Paresis; D010447:Peptide Hydrolases / Q000097:blood*; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood*; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D002097:C-Reactive Protein; D010447:Peptide Hydrolases