Mean Values Of D-dimer Research Articles

Association Between Serum C-Reactive Protein (CRP) And D-Dimer Levels In Covid-19 Patients In A Tertiary Level Hospital, Khulna

Background: The novel corona virus disease 2019 (COVID-19) is major public health issue. It is the most significant global health challenge in the world. Biomarkers play a significant role to detect the severity of COVID-19 infection in the perspective of management of the patients. Aim and objective: We aimed to assess the association between the levels of C-Reactive Protein and D-dimer in COVID-19 patients. Methods: This cross-sectional study was conducted in the department of Pathology and department of Microbiology GMCH, Khulna. 152 patients with SARS-CoV-2 (COVID -19) positive patients were enrolled in this study. C-reactive protein and D-dimer levels are measured in the laboratory of Pathology department, GMCH, Khulna. All statistical computations were performed by using window-based computer software devised with Statistical Packages for Social Sciences (IBM SPSS Statistics 21 version). Results: In this study CRP level was found of mean value of 62.84± 44.64 mg/L with a range of 1.40-195.20 mg/L. It was normal in 21 (13.8%) patients and increased in in 131 patients (86.2 %). The mean value of D-dimer was 2.48 ± 02.20 mg/L with a range of 0.10-9.35 mg/L. D-dimer was normal in 26 (17.1%) patients, whereas it was increased in 126 patients (82.9 %). We performed Pearson’s correlation-coefficient (r) test to compare the association between the levels of CRP with D-dimer in COVID-19 positive patients. There was moderately positive and significant correlation (r = +0.647, p <0.05) between the levels of CRP and D-dimer. Conclusion: There was statistically significant correlation between the levels of serum CRP with D-dimer in COVID-19 positive patients. These two biomarkers can be used to assess the severity in patients with COVID-19 positive with thrombotic disorder for reduction of morbidity and mortality of COVID positive patients. J Dhaka Med Coll. 2023; 32(1) : 57-62

Investigation of the relationship between changes in maternal coagulation profile in the first trimester and the risk of developing preeclampsia

Normal pregnancy is a hypercoagulable state with an increase in coagulation factor levels and a decrease in natural anticoagulation. However, a higher hypercoagulable state with prolonged activated partial thromboplastin time (APTT), prothrombin time (PT), increased D-dimer, and mean platelet volume is seen in women with preeclampsia at the time of onset. In addition, endothelial dysfunction occurs before the clinical symptoms of preeclampsia. Therefore, we undertook this study to investigate the coagulation profile in the first trimester in women who developed preeclampsia later. A total of 853 pregnant women with singleton births at the Obstetrics and Gynecology Hospital of Fudan University between January 2021 and December 2021 were included in this case-control study. In the comparison with the controls (n = 531), the mean value of D-dimer, APTT, thrombin time (TT), antithrombin (AT)), and fibrin degradation products (FDP) was significantly lower in preeclamptic women at the time of diagnosis (n = 322). The changes in the coagulation profile were not associated with the severity or the time of onset. The reduced values of D-dimer, AT, and FDP, and increased values of TT were also observed in the first trimester in women who developed preeclampsia later and were not associated with the severity, or the time of onset of preeclampsia. After adjusting for maternal age and BMI, the values of D-dimer and AT in the first trimester were correlated to the risk of developing preeclampsia. Our findings suggest that there is an abnormal maternal response to the hemostatic system in early gestational age in women who developed preeclampsia later and measuring the coagulation profile could be an additional predictive marker of preeclampsia.

High D-Dimer Level at First Incident Cancer-Associated Venous Thromboembolism is a Predictor for Recurrence

BACKGROUND: Cancer is considered a major risk factor of venous thromboembolism (VTE). Whether the D-dimer level at first incident cancer-associated VTE can predict recurrence is not fully elucidated. AIM: The aim of this study was to assess the association between D-dimer level measured at first incident cancer-associated VTE and risk of recurrence. METHODS: In this study, the electronic records of all patients with first incident cancer-associated VTE were retrospectively retrieved and followed up for a period of 36 months. The measured levels of D-dimer and clinical predictors for each patient prior intervention were collected. Univariate and multivariant Cox regressions were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS: A total of 73 (34.3%) of 213 cancer-associated VTE patients had recurrent VTE. The crude recurrence rate was 11.4/100 person-years (95% CI, 9.2–14.2). The mean value of D-dimer was significantly higher seen in recurrent VTE patients than those without recurrence (14.8 ± 7.5 mg/L vs. 4.8 ± 5.7 mg/L, P < 0.001). The highest positive likelihood ratio using area under the receiver operating characteristic (ROC) curve occurred when a D-dimer threshold of 8.67 mg/L was chosen. At this threshold, the D-dimer was 92% sensitive and 80% specific in predicting recurrent VTE. The area under the ROC curve was 0.924 (95% CI 0.887–0.960, P < 0.001). Patients with a D-dimer ≥8.67 mg/L at first VTE in our study were 3.1-fold more likely to have a recurrence than those with lower D-dimer results. CONCLUSION: A D-dimer ≥8.67 mg/L measured at the first incident cancer-associated VTE was associated with a 3.1-fold increased hazard of recurrence events. Our finding suggests that a low D-dimer level at the time of first cancer-associated VTE is suitable in the clinical practice to avoid extended-duration anticoagulation.

Prognostic role of Interleukin-6/lymphocytes ratio in SARS-CoV2 related pneumonia

Introduction and aimInterleukin-6 to lymphocyte (IL-6/Lym) ratio has been identified as a potential prognostic tool in patients with SARS-CoV2 related pneumonia. The aim of our study was to compare the prognostic power of IL-6/Lym ratio with other biomarkers in patients initially admitted in a non intensive unit and suffering for respiratory failure associated with SARS-CoV2 related pneumonia. Materials and methodsIL-6/Lym ratio, IL-6, D-Dimer, D-Dimer/fibrinogen ratio, fibrinogen, C-reactive protein (CRP), lymphocytes count and neutrophil/lymphocyte (N/L) ratio collected at hospital admission were tested as prognosticators of negative outcome, defined as combined endpoint in-hospital mortality and/or Intensive Care Unit (ICU) admission requiring oro-tracheal intubation (OTI). ResultsStudy population encompassed two hundreds and twenty-three patients (46% females) with mean age ± DS 69.4 ± 13.3 years. Eighty-nine patients (39.9%) suffered for severe respiratory failure and required non invasive ventilation, helmets and/or high flow nasal cannula. Fourty-one patients (18.3%) died during hospital stay and/or required OTI. In these patients mean values of IL-6/Lym ratio, IL-6, CRP and N/L were significantly higher and lymphocytes count was significantly lower compared with patients discharged alive and/or not requiring OTI, while no difference was found in mean values of D-Dimer, D-Dimer/Fibrinogen ratio and fibrinogen. AUC (0.797, 95% CI: 0.738–0.848) of IL-6/Lym ratio was the highest compared with those of all the other analyzed biomarkers and the difference was significant with the exception of IL-6. At multivariate logistic regression IL-6/Lym ratio > 66.5 resulted the only independent biomarker associated with mortality and/or OTI (OR 5.65; 95% 1.63–19.54). ConclusionIL-6/Lym ratio seems to be an optimal prognosticator in SARS-CoV2 related pneumonia. Its routinary use in COVID-19 patients could be warranted.

Clinical picture and laboratory disorders in adult patients with pre-existing cardiomyopathy and COVID infection

Abstract COVID infection is presented with different clinical manifestations in different population groups. A number of studies have shown increased mortality in patients with pre-existing cardiomyopathy, which is common in the elderly population. Patients with COVID infection have an increased incidence of cardiac disease, most commonly myocarditis, acute heart failure and coagulation dysfunction seen after an increase in the value of D-dimer. Methods We analyzed the data of patients hospitalized in our institution for a period of one month (December 2020), positive for COVID 19 virus, with the presence of cardiomyopathy and associated comorbidity, their clinical picture, as well as laboratory tests - with reference to inflammatory markers and D-dimer. Results During the study period, 53 patients were positive for COVID infection. The average age of the patients was 76.01 years. Total mortality was 17.78% (45 patients recovered, while 8 died). We divided the patients into 2 groups - patients with cardiomyopathy before COVID infection and those who did not have it. In the first group 30 patients were included with compensated cardiomyopathy with drugs before COVID infection, and in the second group 23 patients were included without cardiomyopathy. The clinical picture in 75.5% of patients was moderate, in 11.3% it was severe with reduced saturation <92%, while in 13.2% it was asymptomatic. During the infection in some of the above patients there was a deterioration of the clinical picture presented with fever, dyspnoea, cardiac decompensation, pulmonary finding, and increase in inflammatory markers and D-dimer. Mortality in the first group was 20% while in the second 15%. The mean value of D-dimer was 1785.37 ng/ml. The mean value of D-dimer in patients with cardiomyopathy was 2153.21 ng/ml (from 329.28 ng/ml to 5680 ng/ml), while in patients without cardiomyopathy it was 1305.58 ng/ml (from 513.57 ng/ml to 5286.69 ng/ml). The mean value of D-dimer in patients who survived the infection was 1490.84 ng/ml, while the value of D-dimer in deceased patients was 3442.09 ng/ml. CRP was elevated in 88.68% of patients, and 9.43% of patients had values above 100 mg/L indicating severe secondary bacterial infection. In 20% of these patients there was a lethal outcome. The median neutrophil lymphocyte ratio in patients was 5,873. The normal value of this ratio (under 3) had 17 patients (32.07%) in the rest was increased, and over 15 (indicating severe infection) had 7.55% of patients of whom 50% of the infection had a lethal outcome. Conclusion Patients with cardiomyopathy before COVID infection had a more severe clinical picture; they also had heart failure, which increased the risk of lethal outcome. There was also an increasing trend of inflammatory markers and D-dimer. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): PHI Specialized hospital for geriatric and palliative medicine 13 November Skopje

“D-DIMER LEVEL AS PREDICTIVE BIOMARKER FOR COVID-19 DISEASE SEVERITY: AN ANALYSIS”

Objectives- COVID-19 is now a global pandemic and it was rst reported in Wuhan, China, in December 2019. In is observed in few critically ill patients that that he course of disease is rapid and with in short period of time the clinical condition may worsen. Deranged coagulation prole, including elevation of D-dimer level are identied during course of COVID-19 infection. Raised serum level of D dimer is associated with increased mortality in COVID19 Patients. Methods- The data of 128 COVID 19 patients was retrospectively collected and analyzed. After categorization of patients into two groups the optimal cutoff value of D-dimer on admission was evaluated by receiver operator characteristic (ROC) curve. Result- Out of total 128 enrolled in the study, 81(63.28%) patients were in non severe group and 47(36.72%) patients in severe group and mean value of D-dimer in non severe group and severe group was 2.17 (2.78)mg/L, and 11.26 (7.56)mg/L respectively. The area under the curve (AUC) of ROC curve was 0.886 (95% CI 0.818-0.954; p value<0.0001) with optimal threshold value was 2.345 mg/L. Conclusion- In COVID-19 patients D-dimer value ≥ 2.345 mg/L can be used to effectively predict the severity of disease. A signicant association has been found in raised D-dimer level and disease severity.

Does the Platelet Index Have a Guiding Role in the Association of Cancer and Pulmonary Thromboembolism?

Introduction: The diagnostic value of the D-dimer test varies with variable platelet numbers and functions in patients suffering from cancer and concomitant pulmonary thromboembolism (PTE). This requires easy and reliable evaluation tests. In this study, we aimed to investigate the hypothesis that platelet functions may be more guiding in the prediction and diagnosis of PTE rather than the number of platelets in cancer pa- tients. Methods: The clinical, laboratory and radiological findings of all patients diagnosed with PTE were retrieved, retrospectively. Comparisons were performed between “can- cer-free” and “cancer” patients. The patients were also evaluated according to their active and remission status. Results: The data of 232 patients with PTE were reviewed. 172 patients were cancer- free and 60 were diagnosed with cancer. The mean values of D-dimer, mean platelet volume (MPV) and platelet distribution width (PDW) were found to be significantly higher in patients with cancer (P=0.015, P=0.026, and P=0.023; respectively). On the other hand, mean platelet counts were significantly higher in patients without cancer (P=0.05). It was also observed that the mean values of D-dimer, Troponin-I, MPV, and PDW were found to be significantly higher in patients with active cancer (P=0.05, P=0.044, P=0.05, and P=0.042; respectively). However, the mean platelet counts were significantly higher in patients with cancer who were in remission (P=0.05). Conclusions: The morphological characteristics of the platelets are more determinant than the number of platelets in cancer patients with PTE. Platelet indexes such as MPV and PDW may be useful in the prediction, diagnosis, and follow-up of PTE in patients with cancer.

Venous Thromboembolism During Ten-year Follow up on Clinical Center University of Sarajevo.

Introduction:Venous thromboembolism (VTE) consists of two entities, deep venous thrombosis (DVT), and its complication, pulmonary embolism (PE). The main therapeutic goal is the prevention of this complication.Aim:The aim of the study was to present epidemiological data of patients with the diagnosis of deep venous thrombosis, with regard to the location of thrombosis, the value of fibrinogen and D-dimer in relation to the sex of the patients, the presentation of therapeutic modality, with the presentation of PE and treatment outcomes.Methods:The study has a retrospective and observational feature, covering the period from 2008 to 2017, and included 1154 patients with the diagnosis of deep venous thrombosis as a basic criterion for inclusion. Data on sex, age, diagnosis with thrombosis localization, hospitalization duration, administered therapy, D-dimer and fibrinogen values, pulmonary thromboembolism and mortality were collected.Results:The deep venous thrombosis was mostly located at the lower limbs - in 1079 respondents (93.5%), then at the upper limbs in 65 (5.63%) cases. The left side is more represented (58.9%) than the right (40.3%), which is statistically significant (χ2=40.03, p<0.005), while 0.9% of patients had DVT bilaterally. At the lower limbs is the most common iliac thrombosis, represented in 47% of thrombosis cases at the lower limbs. Subclavian axillary thrombosis has been reported in ¾ cases at the upper limbs. The mean fibrinogen concentration in all respondents is 5.2 mg/L, for men 5.0 mg/L and for women 5.3 mg/L, above the reference values (1.8-3.8 g/L). The mean value of D-dimer was 7.33 mg/L for all respondents, 8.46 mg/L for women and 6.5 mg/L for men, which was high above the reference limit (0.55 mg/L). From baseline, 88 (7.6%) of respondents had proven/high-grade pulmonary thromboembolism as a DVT complication in the observed period. Pearson correlation established a positive correlation between lethal outcome and patient age, r=0.13, p<0.005, followed by a higher incidence of lethal outcome after DVT in older patients.Conclusion:The incidence of venous thromboembolism is approximately equal among the genders, and increases with the age of the patients, especially in men. Fibrinogen and D-dimer values in hospitalized patients are higher than the reference, in both cases more among women. Multidisciplinary approach to patients, in cooperation with angiologists, pulmonologists, cardiologists and nuclear medicine specialists is an imperative. The development of a state-level registry that would follow the incidence of deep venous thrombosis, with reference to risk factors, is imperative and necessary in planning of community health system.

Correlation of coagulation markers with axillary lymph node metastasis in carcinoma breast

Background: Lymph node metastasis has been shown to be the most important prognostic marker for carcinoma breast. Lymph node involvement is not only a prognosis marker, but also an important guiding factor in deciding surgical plan as well as postoperative therapy. The aim of the study was to assess role of coagulation markers (D-dimer and factor VIII) value as predictive markers of lymph node metastasis in breast cancerMethods: A prospective study was conducted in the Department of Surgery in with help of Departments of Biochemistry, Pathology and Radiology, KAPV&amp;MGMGH, Trichy. 50 female patients who were diagnosed and treated as carcinoma breast in the department of surgery, MGMGH Trichy. The following variables were studied: 1. Age of patient 2. TNM stage of patients. 3. D-dimer levels 4. Factor VIII levels.Results: There was statistically significant relationship between mean values of D-dimer and factor VIII levels and advancing stage of disease, number of pathological axillary lymph node involved, increase in histological grade of tumor, Lymphovascular invasion.Conclusions: D-dimer and factor VIII may be used as yardstick for systemic adjuvant therapy in patients with node negative, &lt;1 cm carcinoma breast. D-dimer may prove to be a safe, convenient and easily available biomarker which can be combined with conventional sentinel node biopsy in clinically node negative breast cancer to assess metastatic-disease in axilla and reduce false negative results.

Thrombophilia Markers in Patients with Recurrent Early Miscarriage.

This study was to investigate the association between thrombophilia and REM by the change of thrombophilia markers and to evaluate their contribution in diagnosis and treatment of REM. 199 women with REM history were divided into two groups within the study group: 151 pregnant (REM-P) and 48 nonpregnant (REM-NP). In addition, 121 healthy age-matched women without REM history were divided into two groups of the control group: 75 pregnant (Control-P) and 46 nonpregnant (Control-NP). Lupus anticoagulant (LA), anticardiolipin antibodies (ACA), and anti-β2-glycoprotein-I antibodies (anti-β2GPI-ab) and coagulation-related factors such as protein S (PS), protein C (PC), anti-thrombin III (AT-III), and D-dimer were analysed. The prevalence of antiphospholipid antibodies (aPL) and the coagulation-related factors between groups were compared. The overall prevalence of aPL positivity in REM-P (14.57%) showed a difference compared with REM-NP (2.66%) but not for aCL, anti-β2GPI-ab or LA alone. There were significant differences in the mean levels of protein S, protein C, and AT-III in REM-P. The mean values of protein C (90.3 ± 28.42%) and protein S (71.80 ± 24.68%) in the aPL positive study group were similar with that of the aPL negative study group (p = 0.406, p = 0.880). Comparing with the aPL negative study group, the mean value of AT-III (87.71 ± 21.84%) was significantly lower (p = 0.018), while the mean value of D-dimer (0.98 ± 1.1 mg/L FEU) was significantly higher (p = 0.013). We briefly address the role of the prevalence of aPL and the related coagulation factors for predicting a prethrombotic state in patients with REM. The results of the use of anticoagulants for treating REM are encouraging.

D-dimer: A useful marker in neonatal sepsis

Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte sedimentation rate and total leucocyte count (TLC) in predicting sepsis. Study Design: Prospective observational hospital based study. Setting: Tertiary care hospital. Subjects: From November 2010 to October 2011, 936 neonates were admitted to the neonatal unit of Indira Gandhi Medical College, Shimla, Himachal Pradesh. Out of these, 355 neonates were admitted with suspected sepsis. Out of these, only 101 term neonates were without asphyxia and blood culture positive and were enrolled as cases, and 96 term neonates without the asphyxia admitted for neonatal jaundice without sepsis were enrolled as controls. Methods: All neonates, cases and control were investigated as per the protocol at admission and simultaneously the D-dimer levels were measured. D-dimer levels were evaluated in predicting neonatal sepsis and were compared with other established markers of sepsis in predicting sepsis. Results: In the study group, age ranged from 0 to 22 days with an average of 5.58 days. In the control group, age ranged from 0 to 23 days with an average of 5.62 days. Sex distribution was almost equal in both groups. The mean value of D-dimer in the cases and control group were 1.832 mg% and 1.365 mg% respectively. The study group had significantly higher values of D-dimer (P - 0.04). Sensitivity and negative predictive value of D-dimer in predicting sepsis were 90.0% and 84.4% respectively, the highest amongst all the markers studied in sepsis. Positive predictive value and specificity of TLC in sepsis was highest in all the marker studied. Negative predictive value of various markers was comparable in sepsis. Conclusion: D-dimer is a sensitive predictor of sepsis in neonates with a high sensitivity and negative predictive value. Hence, it should be included in the septic screening of newborns.

Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

Pulmonary thromboembolism (PTE) may increase D-dimer and decrease fibrinogen levels. However, in settings such as intensive care units (ICU) and in long-term hospitalised patients, several factors may influence D-dimer and fibrinogen concentrations and make them unreliable indicators for the diagnosis of PTE. The aim of this study was to evaluate the accuracy of D-dimer:fibrinogen ratio (DDFR) for the diagnosis of PTE in ICU patients. ICU patients who were suspected of having a first PTE and had no history of using anti-coagulants and contraceptives were included in the study. Levels of D-dimer and fibrinogen were measured for each patient prior to any intervention. Angiography or CT angiography was done in order to establish a definite diagnosis for each patient. Suitable analytical tests were performed to compare means. Eighty-one patients were included in the study, of whom 41 had PTE and 40 did not. Mean values of D-dimer and fibrinogen were 3.97 ± 3.22 µg/ml and 560.6 ± 197.3 mg/dl, respectively. Significantly higher levels of D-dimer (4.65 ± 3.46 vs 2.25 ± 2.55 µg/ml, p = 0.006) and DDFR (0.913 ± 0.716 vs 483 ± 0.440 × 10-(3), p = 0.003) were seen in PTE patients than in those without PTE. Receiver operating characteristic (ROC) analysis showed a 70.3% sensitivity and 70.1% specificity with a D-dimer value of 2.43 µg/ml (AUC = 0.714, p = 0.002) as the best cut-off point; and a 70.3% sensitivity and 61.6% specificity with a DDFR value of 0.417 × 10-(3) (AUC = 0.710, p = 0.004) as the best cut-off point. In backward stepwise regression analysis, DDRF (OR = 0.72, p = 0.025), gender (OR = 0.76, p = 0.049) and white blood cell count (OR = 1.11, p = 0.373) were modelled (p = 0.029, R(2) = 0.577). For diagnosis of PTE, DDFR can be considered to have almost the same importance as D-dimer level. Moreover, it was possible to rule out PTE with only a D-dimer cut-off value < 0.43 mg/dl, without the use of DDFR. However, these values cannot be used as a replacement for angiography or CT angiography.

THROMBOPHILIC ABNORMALITIES AMONG PATIENTS WITH CRANIAL DURAL ARTERIOVENOUS FISTULAS

Dural sinus thrombosis often accompanies or precedes the development of dural arteriovenous fistulas (DAVFs). Because thrombophilic abnormalities can contribute to sinus thrombosis, we investigated the prevalence of such abnormalities and of venous sinus thrombosis in patients with DAVFs. Thrombophilic factors were measured in 18 patients with DAVFs treated with embolization at our university hospital. Control data were obtained from patients with unruptured intracranial aneurysms. In addition to sinus occlusion, we investigated prothrombin time, activated thromboplastin time, platelet count, and fibrinogen, platelet, antithrombin III, protein C, protein S, anticardiolipin antibody, anti-cardiolipin beta2-glycoprotein-I complex antibody, and D-dimer levels. Of the 18 patients with DAVFs, 16 had abnormal D-dimer levels, whereas the mean values for other thrombophilic factors were nearly normal. D-dimer levels were significantly higher in preoperative DAVF patients than in controls. Interestingly, the mean value of D-dimer was higher in patients with sinus occlusion than in those without it (3.33 versus 1.19). D-dimer levels rose after embolization in eight out of 10 serially tested patients, but, on average, the change was not significant. In clinically cured patients treated more than 3 months before, D-dimer was lower than in preoperative patients. D-dimer is a very sensitive indicator of acute venous thrombosis, suggesting that elevations in patients with DAVFs are likely to reflect sinus thrombosis. D-dimer values decreased and nearly normalized in clinically cured patients during a long-term follow-up period, a finding consistent with completion of thrombosis and cure of the disease. To clarify the correlation between DAVF and sinus thrombosis from the aspect of etiology, we should thoroughly check the variation in the concentration of the thrombophilic factors in the patient with chronic sinus occlusion to know the variation in the fistula formation in the further study.

Hypercoagulable state under low-intensity warfarin anticoagulation assessed with hemostatic markers in cardiac disorders

The hemostatic condition under low-intensity anticoagulation in cardiac disorders is not fully elucidated. The aim of this study was to ascertain whether hemostatic molecular markers are a useful assessment for anticoagulation to detect the hypercoagulable state. A hematologic study was performed in 75 outpatients, without thromboembolic episodes, treated with low-intensity anticoagulation (average international normalized ratio [INR] 1.72) because of potential cardiac sources of arterial emboli, and in 40 age-matched control subjects. The average level of thrombin-antithrombin III complex (TAT) was significantly lower in patients than in control subjects (p = 0.005), and the mean value of D-dimer was not statistically different between patients and control subjects. Although TAT correlated moderately with D-dimer (r = 0.45, p = 0.0001), INR did not correlate with TAT or D-dimer. Elevated TAT > 3.0 ng/ml and/or D-dimer > 150 ng/ml were observed in 15 patients (20.0%), whereas the remaining 60 patients (80.0%) had no obvious increase in the level of TAT or D-dimer at overall INR. Antithrombin III activity did not correlate significantly with INR, but protein C activity and free protein S antigen showed a significant negative relation to INR (r = 0.82, r = 0.62, respectively, p = 0.0001). Low-intensity anticoagulation was sufficient to reduce coagulation and subsequent fibrinolytic activation in cardiac disorders, but may not be sufficient in some patients with elevated TAT or D-dimer concentration. Under anticoagulation, prothrombin time does not directly reflect in vivo thrombin generation, whereas TAT or D-dimer is useful in detecting a hypercoagulable state, particularly in the low-intensity anticoagulant range.

Fibrinogen, D-Dimer and Thrombin-Antithrombin Complexes in a Random Population Sample: Relationships with Other Cardiovascular Risk Factors

Fibrinogen is an independent risk factor for cardiovascular disease and both D-Dimer and Thrombin-Antithrombin complexes may be suitable as laboratory markers of deep venous thrombosis and are becoming more widespread in clinical practice. The aim of our study was to evaluate their normal range and to examine their correlation with various cardiovascular risk factors. Fibrinogen, D-Dimer and Thrombin-Antithrombin complexes were assessed in 516 normal subjects randomly selected from the National Health Service register of Trieste (Italy). In our community the mean value of fibrinogen was 283 +/- 71 mg/dl. Fibrinogen increases with age in males and was significantly higher in male smokers. In non-smokers, females had significantly higher fibrinogen values than males. The mean value of D-Dimer was 306 +/- 130 ng/ml. In females it is significantly higher. The fibrinogen and D-Dimer correlation coefficient was 0.20 (p < 0.001). The mean level of Thrombin-Antithrombin complexes was 6.25 +/- 6.8 ng/ml with a distribution markedly skewed towards the left; males had lower concentration than females (p = 0.047). Multiple regression analysis for fibrinogen as a dependent variable showed that D-Dimer, LDL-cholesterol, Body-Mass Index and Thrombin-Antithrombin complexes were poor predictors for fibrinogen plasma levels (R2 = 0.23) and that fibrinogen, ApoA1 and age can explain only about 10% of the observed variability in D-Dimer.