title: Diagnostic possibilities of specific fibrin(ogen) degradation products in relation to venous thromboembolism.
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.
authors.affiliation: Department of Clinical Chemistry, St Antonius Hospital, Nieuwegein, the Netherlands. fjlmhaas@caiway.nl
authors.forename: Fred J L M
authors.initials: FJ
authors.lastname: Haas
authors.forename: Roger E G
authors.initials: RE
authors.lastname: Schutgens
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
authors.forename: Ria H
authors.initials: RH
authors.lastname: Laterveer
authors.forename: Cornelis
authors.initials: C
authors.lastname: Kluft
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059748:Proteolysis; D012372:ROC Curve; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005337:Fibrin; D005340:Fibrinogen