Dimerized plasmin fragment D as a potential biomarker to predict successful catheter-directed thrombolysis therapy in acute deep vein thrombosis

Abstract

Objectives

The value of dimerized plasmin fragment D in the clinical monitoring during the catheter-directed thrombolysis in patients with acute deep vein thrombosis is not known.

Methods

Dimerized plasmin fragment D levels in 24 patients with acute deep vein thrombosis undergoing catheter-directed thrombolysis were prospectively evaluated. The plasma dimerized plasmin fragment D level was measured serially before and at every 12 h during catheter-directed thrombolysis for 24 h. Technical success was defined as restoration of patency and flow with less than 50% residual thrombus by surveillance rotational venography.

Results

Technical success was achieved in 79.2% (19 of 24) of the treated limbs after catheter-directed thrombolysis. In univariate analysis, there was significant elevation of the dimerized plasmin fragment D at 12th h after starting the catheter-directed thrombolysis (P < 0.05) in patients with less than 50% residual thrombus stenosis. The optimal cut-off value of dimerized plasmin fragment D to predict successful catheter-directed thrombolysis was determined as 18.4 µg/ml at the 12th h after starting the catheter-directed thrombolysis with sensitivity 0.8 and specificity 0.8 (P = 0.03). It was further validated in multivariate logistic regression analysis (odds ratio: 14.38; 95% CI: 1.22–169.20; P = 0.03).

Conclusions

Catheter-directed thrombolysis is safe and effective for restoration of blood flow in patients with acute deep vein thrombosis. Dimerized plasmin fragment D value greater than 18.4 µg/ml at the 12th h after starting catheter-directed thrombolysis had a high predictive rate of greater than 50% lysis at the end of catheter-directed thrombolysis.

Keywords

Deep vein thrombosis fibrinolytic therapy fibrin fragment D peripheral venous catheterization percutaneous transluminal angioplasty

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References

Lin

Ochoa

Duffy

. Catheter-directed thrombectomy and thrombolysis for symptomatic lower-extremity deep vein thrombosis: review of current interventional treatment strategies. Perspect Vasc Surg Endovasc Ther 2010; 22: 152–163.

Mewissen

Seabrook

Meissner

. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999; 211: 39–49.

Nazir

Ganeshan

Nazir

. Endovascular treatment options in the management of lower limb deep venous thrombosis. Cardiovasc Intervent Radiol 2009; 32: 861–876.

Patterson

Hinchliffe

Loftus

. Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis. Arterioscler Thromb Vasc Biol 2010; 30: 669–674.

Protack

Bakken

Patel

. Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement (discussion 7). J Vasc Surg 2007; 45: 992–997.

Cynamon

Stein

Dym

. A new method for aggressive management of deep vein thrombosis: retrospective study of the power pulse technique. J Vasc Interv Radiol 2006; 17: 1043–1049.

Enden

Haig

Klow

. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012; 379: 31–38.

Gogalniceanu

Johnston

Khalid

. Indications for thrombolysis in deep venous thrombosis. Eur J Vasc Endovasc Surg 2009; 38: 192–198.

Kelly

Hunt

. The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism. J Thromb Haemost 2003; 1: 1888–1896.

10.

Wells

. The role of qualitative D-dimer assays, clinical probability, and noninvasive imaging tests for the diagnosis of deep vein thrombosis and pulmonary embolism. Semin Vasc Med 2005; 5: 340–350.

11.

Wilson

Gard

. Evaluation of an automated, latex-enhanced turbidimetric D-dimer test (advanced D-dimer) and usefulness in the exclusion of acute thromboembolic disease. Am J Clin Pathol 2003; 120: 930–937.

12.

Ouriel

Shortell

Azodo

. Acute peripheral arterial occlusion: predictors of success in catheter-directed thrombolytic therapy. Radiology 1994; 193: 561–566.

13.

Ouriel

Shortell

DeWeese

. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg 1994; 19: 1021–1030.

14.

Budzynski

Marder

Parker

. Antigenic markers on fragment DD, a unique plasmic derivative of human crosslinked fibrin. Blood 1979; 54: 794–804.

15.

Roberts

Patel

Chitongo

. Presenting D-dimer and early symptom severity are independent predictors for post-thrombotic syndrome following a first deep vein thrombosis. Br J Haematol 2013; 160: 817–824.

16.

Bates

. D-dimer assays in diagnosis and management of thrombotic and bleeding disorders. Semin Thromb Hemost 2012; 38: 673–682.

17.

Kodama

Seki

Masahiro

. D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer. Ann Oncol 2010; 21: 1651–1656.

18.

Kurklinsky

Kalsi

Wysokinski

. Fibrin D-dimer concentration, deep vein thrombosis symptom duration, and venous thrombus volume. Angiology 2011; 62: 253–256.