Plasma D-dimer Concentration Research Articles

Pleural Effusion and Plasma Levels of Fibrinolytic Parameters in Tuberculosis Pleurisy and Contribution to the Diagnosis

Objective: The presence of a relationship between tuberculosis and hypercoagulability has been reported. In the case of the occurrence of hypercoagulability, the body responds by activating the fibrinolytic system. In this study, we aimed to investigate the values of fibrinolytic parameters and their contribution to the diagnosis in patients with tuberculosis pleurisy (TP). Methods: Forty four patients with tuberculosis pleurisy (30 cases), malignant plural effusion (8 cases), and transudative pleural effusion (6 cases) were involved in the study. Transudative and malignant fluids constituted the control group. The concentrations of pleural fluid and plasma D-Dimer, fibrinogen, tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), t-PA/PAI-1 complexes and serum, and pleural fluid, adenosine deaminase (ADA), glucose, lactate hydrogenase (LDH), total protein and albumin levels of the cases were measured. Results: In the patients with tuberculosis pleurisy, the values of pleural fluid fibrinogen and pleural fluid PAI-1 were found to be significant ly higher according to the results of Mann-Whitney U test (p≤0.05 and p≤0.001, respectively). Conclusion: In tuberculosis pleurisy, fibrinolytic system activates in parallel with the increased hypercoagulation and fibrinolytic parame ters also increase. These parameters can be benefited unless the diagnosis of tuberculosis pleurisy can be established through conventional diagnostic methods.

Progression of plasma D-dimer concentration and coagulopathies during hospitalization in horses with colic.

To assess the progression of plasma D-dimer concentrations and coagulation status in horses with different types of colic. Prospective clinical observational study performed between March 2004 and September 2008. Veterinary university teaching hospital. Horses admitted and treated for colic and hospitalized for >48 hours were considered. Animals were classified by diagnosis into medical obstructive conditions (MO), surgical obstructive conditions (SO), inflammatory conditions, and ischemic lesions (IS). Three blood samples were obtained from each horse (admission, at 24-48 h [or after surgery] and upon discharge). For each sample, plasma D-dimer concentration, prothrombin time, activated partial thromboplastin time, antithrombin activity, and the presence of subclinical disseminated intravascular coagulation were determined. When median plasma D-dimer concentration values at admission and after 24-48 hours were compared, they were different but stable in horses with MO (1.29-1.95 nmol/L) and inflammatory conditions (5.70-6.69 nmol/L). However, 10-fold and 5-fold increases were observed, respectively, in SO (2.08 to 16.38 nmol/L) and IS (3.08 to 15.91 nmol/L) in the postoperative period. By 24-48 hours, the percentage of horses with coagulopathy increased in most groups (MO, 43 to 58%; SO, 50 to 96%, IS, 53 to 90%). By the time of discharge, 87% of horses with SO problems and 89% of horses with IS still had some form of coagulopathy documented. Throughout hospitalization, horses with MO problems had less severe coagulopathy and lower plasmatic D-dimer concentrations compared to other groups of horses. On admission, most horses with inflammatory conditions presented with coagulopathy. At 24-48 hours of hospitalization and following surgery, the hemostatic profile can differ markedly when compared to admission values.

Plasma concentrations of D-dimer and outcome of in vitro fertilization.

BackgroundThe activation of blood coagulation could contribute to the failure of in-vitro fertilization (IVF) techniques. The aim of this study was to assess the predictive value of D-dimer levels for pregnancy outcome in women undergoing IVF.FindingsA prospective study was performed in 105 women undergoing IVF. D-dimer was measured before and one week after the administration of recombinant human chorionic gonadotropin (r-hCG). The primary outcome of the study was clinical pregnancy. The mean age was 36 years (range 26 to 43 years). The main indications for IVF were infertility due to a tubaric (n = 21, 20%) or male factor (n = 37, 35%) and idiopathic infertility (n = 30, 29%) which altogether accounted for 84% of the total. Clinical pregnancy was achieved by 40/105 (38%) women of whom 32 (80%) delivered a live child. On the day of r-hCG administration, D-dimer concentrations were significantly higher in patients not achieving a clinical pregnancy (141 ng/dL vs. 115 ng/dL, p = 0.035) which remained statistically significant after correction for age and indications for IVF in multivariable analysis (p = 0.032). One week after r-hCG, the levels of D-dimer were significantly increased both in women with and without a clinical pregnancy with no differences between the groups (748 ng/dL vs. 767 ng/dL, p = 0.88).ConclusionsD-dimer concentrations seem to predict a higher risk of pregnancy failure in women undergoing IVF. If confirmed in future prospective studies, D-dimer could help identifying a group of patients who could benefit from prophylaxis to increase the pregnancy success rate.

Evaluation of Plasma D-dimer Concentration in Cats with Hypertrophic Cardiomyopathy

Arterial thromboembolism (ATE) is a common and fatal complication of hypertrophic cardiomyopathy (HCM) in cats. Therefore in this study, we evaluated the hypercoagulability (using plasma concentration of D-dimer) in HCM cats with different stage of heart failure and left atrial enlargement and also investigated the any correlation with echocardiographic indices (including left free wall thickness at diastole, interventricular septal thickness at diastole, LA to Ao ratio, heart failure stage, existence of systolic anterior motion of mitral valve). The median plasma D-dimer concentration in this study population was 0.51 ± 0.70 (range 0 to 2.50) ㎍/mL in the control group, 1.47 ± 1.29 (range 0.3 to 5.79) ㎍/mL in the HCM group, 1.48 ± 1.65 (range 0.3 to 5.79) ㎍/mL in the ISACHC I group, 1.62 ± 0.4 (range 1.31 to 2.07) ㎍/mL in the ISACHC II group, 1.36 ± 0.91 (range 0.3 to 2.31) ㎍/mL in the ISACHC III group, 1.90 ± 1.60 (range 0.3 to 5.79) ㎍/mL in the cat with LA dilation, 1.72 ± 0.72 (range 0.6 to 2.31) ㎍/mL in cats with SEC-T, 1.19 ± 0.70 (range 0.3 to 2.31) ㎍/mL in the cats with SAM, and 1.63 ± 0.80 (range 0.6 to 2.31) ㎍/mL in the cats with ATE. Our study found the median and mean concentration of plasma D-dimer was higher in cat with HCM, ATE, SECT and SAM and clearly provides evidence of hypercoagulability in cats with HCM, although the severity was not correlated to the dilation of LA and the presence of heart failure. This is the first study evaluating the hypercoagulability in cats with HCM in Korea.

Assessment of Biomarkers and Predictive Model for Short-term Prospective Abdominal Aortic Aneurysm Growth—A Pilot Study

Abdominal aortic aneurysms (AAAs) are currently followed with serial ultrasound or computed tomography scanning diameter measurements, but evidence shows that AAA expansion is mostly discontinuous and quite unpredictable in any given patient. A reliable predictive model of AAA growth and/or rupture risk could help individualize treatment, follow-up protocols, and cost-effectiveness. Our objective is to set a predictive model of short-term prospective AAA growth, after clinical, serologic, and anatomic data. A prospective pilot cohort was designed. We recruited 96 consecutive, asymptomatic, infrarenal, atherosclerotic AAA patients. We registered clinical data (age, gender, cardiovascular risk factors, comorbidity, and statin intake), baseline aortic diameter, prospective 1-year AAA growth, and the concentration of metalloprotease-2, metalloprotease-9, cystatin C, α1-antitrypsin, myeloperoxidase, monocyte chemoattractant protein-1, homocysteine, D-dimer, plasmin-antiplasmin complex (PAP), and C-reactive protein in peripheral blood at the time of baseline assessment. With all these data, we elaborated predictive models for 1-year AAA growth assessed both as a continuous variable (mm/year) and a dichotomic one (defined as stability, if AAA growth rate was ≤2mm/year, versus expansion, if AAA growth rate was >2mm/year), using simple and multiple linear and logistic regression. The multivariate model confirmed the independent impact of D-dimer levels and chronic renal failure (CRF) on increasing AAA growth rates. Every increase by 1ng/mL in the plasma concentration of D-dimer was related to a mean 1-year increase of 0.0062mm in the AAA growth. Likewise, CRF increased the 1-year prospective AAA growth by a mean of 2.95mm. When we assessed AAA growth as a dichotomic variable, the increase in the peripheral concentrations of PAP slightly increased the risk of AAA expansion (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00-1.02), but the presence of CRF increased the risk dramatically (OR: 14,523.62; 95% CI: 0-7.39E+40). Plasma D-dimer and PAP levels seem promising biomarkers of short-term AAA activity. CRF is an important independent prognostic factor of AAA expansion. The dichotomic classification of AAA growth, as stability versus progression, can be useful in the development of management models and their clinical application.

Elevated Plasma D-Dimer Levels Correlate with Long Term Survival of Gastric Cancer Patients

BackgroundIncreasing evidence indicated plasma D-dimer could be regarded as a marker in cancers, however, its role in gastric cancer is still largely unknown.MethodsPlasma D-dimer levels were measured by enzyme linked fluorescent immunoassays and evaluated by receiver operating characteristic (ROC) curves for peritoneal dissemination in gastric cancer and healthy subjects. The overall survival (OS) characteristics were determined using Kaplan–Meier and Cox regression analyses.ResultsThe average of the plasma D-dimer levels for gastric cancer patients was significantly higher than the healthy subjects. A Spearman correlation analysis showed that plasma D-dimer levels correlated with the depth of invasion, lymph node metastasis, peritoneal dissemination, distant metastasis, tumor size and TNM stage. The mean plasma D-dimer level was 2.20±1.51 µg/mL in peritoneal dissemination patients and 1.01±0.79 µg/mL in non-peritoneal dissemination patients (P<0.001). Additionally, the mean plasma D-dimer concentration in patients alive at the final follow-up evaluation was 0.79±0.72 µg/mL,which was significantly lower than the amounts determined for the deceased patients (1.36±1.13 µg/mL) (P<0.001). The AUC of D-dimer was 0.833 (95%CI: 0.780–0.885). At a cut-off value of 1.465 µg/mL, the D-dimer measurement had a sensitivity of 78.00%, a specificity of 83.76% and an accuracy of 82.59%. The median OS was 48.10 months (95% CI: 43.88–52.31) in patients with plasma D-dimer levels less than 1.465 µg/mL and 22.39 months (95% CI: 16.95–27.82) in patients with plasma D-dimer levels exceeding 1.465 µg/mL (log-rank test, P<0.001). Importantly, plasma D-dimer levels exceeding 1.465 µg/mL were significantly associated with poor OS, as determined using a multivariate Cox regression analysis (hazard ratio [HR], 2.28; 95%CI: 1.36–3.81; P = 0.002).ConclusionsPlasma D-dimer levels are increased in gastric cancer patients and may be a valuable biomarker for peritoneal dissemination, with high D-dimer levels predicting poor outcomes for gastric cancer patients.

Endogenous tissue plasminogen activator enhances fibrinolysis and limits thrombus formation in a clinical model of thrombosis

Purpose: Fibrinolysis inhibits thrombus propagation on the surface of unstable atherosclerotic plaques. Using a clinical model of deep arterial injury, we assessed the ability of exogenous and endogenous tissue Plasminogen Activator (t-PA) to limit acute in situ thrombus formation. Methods and results: Ex vivo thrombus formation was assessed in the Badimon Chamber at low and high shear rates in two double-blind randomised cross-over studies of 20 healthy volunteers during extracorporeal administration of recombinant t-PA (0, 40, 200 and 1000 ng/mL) or during endogenous t-PA release stimulated by intra-arterial bradykinin infusion in the presence or absence of oral enalapril. Recombinant t-PA caused a dose-dependent reduction in thrombus area under low and high shear conditions (p<0.001 for all). Intra-arterial bradykinin increased plasma t-PA concentrations in the chamber effluent (p<0.01 for all versus saline) that was quadrupled in the presence of enalapril (p<0.0001 versus placebo) (Figure 1, panel A). These increases were accompanied by an increase in plasma D-dimer concentration (p<0.005 for all versus saline) (Figure 1, panel B) and, in the presence of enalapril, a reduction in thrombus area in the low shear (16%±5%, p=0.03) (Figure 1, panel C) and a trend towards a reduction in the high shear chamber (13%±7%, p=0.07) (Figure 1, panel D). ![Figure][1] Figure 1 Conclusions: Using a well-characterised clinical model of coronary arterial injury, we demonstrate that endogenous t-PA released from the vascular endothelium enhances fibrinolysis and limits in situ thrombus propagation. These data support a crucial role for the endogenous fibrinolytic system in vivo and suggest that continued exploration and manipulation of its therapeutic potential is warranted. [1]: pending:yes

Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection

ObjectiveTo evaluate the role of D-dimer and C reactive protein (CRP) in predicting inhospital death in acute aortic dissection (AD).DesignA single-centre prospective study.SettingUniversity hospital in China.Patients114 patients with acute AD.InterventionAdmission...

Evaluation of coagulation in dogs with partial or complete extrahepatic biliary tract obstruction by means of thromboelastography

To characterize in vitro coagulation status in a cohort of dogs with extrahepatic biliary tract obstruction (EHBO) and to evaluate these patients for hypercoagulability by means of thromboelastography. Prospective cohort study. Animals-10 dogs with EHBO and 19 healthy control dogs. Partial or complete EHBO was confirmed via exploratory celiotomy. Venous blood samples were collected for evaluation of prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen and D-dimer concentrations; protein C and antithrombin activities; and factor VII, VIII, and XI coagulant activities in plasma as well as thromboelastography in whole blood. Thromboelastography variables were measured from the thromboelastography tracing, and a coagulation index was calculated. Thromboelastography results were compared with those of healthy control dogs previously evaluated by the same laboratory. Hypercoagulability was diagnosed in all dogs with EHBO on the basis of a high coagulation index. Thromboelastography variables, including maximal amplitude, α-angle, and coagulation index, were significantly higher, and K (clot formation time) and R (reaction time) were significantly lower in these dogs than in control dogs. All dogs with EHBO had PT and APTT within respective reference ranges. Plasma D-dimer and fibrinogen concentrations were above reference ranges in 8 and 7 dogs, respectively, and protein C and antithrombin activities were below reference ranges in 3 and 1 dogs, respectively. In vitro hypercoagulability was commonly detected in dogs with naturally occurring EHBO. The traditional view of EHBO as a disease that causes hypocoagulability may need to be reconsidered.

Endogenous Tissue Plasminogen Activator Enhances Fibrinolysis and Limits Thrombus Formation in a Clinical Model of Thrombosis

Using a clinical model of deep arterial injury, we assessed the ability of exogenous and endogenous tissue plasminogen activator (t-PA) to limit acute in situ thrombus formation. Ex vivo thrombus formation was assessed in the Badimon chamber at low and high shear rates in 2 double-blind randomized cross-over studies of 20 healthy volunteers during extracorporeal administration of recombinant t-PA (0, 40, 200, and 1000 ng/mL) or during endogenous t-PA release stimulated by intra-arterial bradykinin infusion in the presence or absence of oral enalapril. Recombinant t-PA caused a dose-dependent reduction in thrombus area under low and high shear conditions (P<0.001 for all). Intra-arterial bradykinin increased plasma t-PA concentrations in the chamber effluent (P<0.01 for all versus saline) that was quadrupled in the presence of enalapril (P<0.0001 versus placebo). These increases were accompanied by an increase in plasma D-dimer concentration (P<0.005 for all versus saline) and, in the presence of enalapril, a reduction in thrombus area in the low shear (16±5; P=0.03) and a trend toward a reduction in the high shear chamber (13±7%; P=0.07). Using a well-characterized clinical model of coronary arterial injury, we demonstrate that endogenous t-PA released from the vascular endothelium enhances fibrinolysis and limits in situ thrombus propagation. These data support a crucial role for the endogenous fibrinolytic system in vivo and suggest that continued exploration and manipulation of its therapeutic potential are warranted.

Assessment of some plasma fibrinolytic proteins in sickle cell anemia patients in steady state and in vaso-occlusive crises

Background: The clinical manifestations of vaso-occlusion result from a dynamic combinations of abnormalities in hemoglobin (Hb) structure and functions, red blood cell membrane integrity, erythrocyte density, endothelial activation, microvascular tone, inflammatory mediators and coagulation factors. Objective: The objective of the following study is to determine the changes in plasma concentration of fibrinolytic proteins among sickle cell anemia (SCA) patients in two clinical states; steady state and vaso-occlusive crises (VOC) and compare with HbAA controls and also to determine if any, the clinical relevance of these proteins in evaluating these patients in the different clinical state. Materials and Methods: A total of 25 (14M: 11F) HbSS subjects in VOC, 24 (13M: 11F) HbSS subjects in a steady state and 30 (17M: 13F) healthy HbAA volunteers matched for age and sex with the subjects were recruited for the study. Hematological parameters, i.e., full blood count, fibrinolytic proteins concentration including plasma concentration of D-dimer, plasminogen, fibrinogen (FBG), tissue plasminogen activator (tPA) and fibrinopetide-A were determined. Result: Plasma fibrinopeptide A (FPA) concentration of 680.99 ΁ 411.37 ng/ml for SCA subjects in VOC and 449.67 ΁ 310.01 ng/ml in steady state subjects were significantly increased (P Conclusion: The significant increase in FPA concentration observed among subjects compared to controls may have been confounded by hyperleucocytosis especially polymorphonuclear leucocytes commonly associated with SCA. Thus, the clinical relevance of these plasma proteins in evaluating these patients in either of the clinical states of this disorder is doubtful.

Cross-Reactivity of the Anti-Human D-dimer Monoclonal Antibody 1C9-6F10 to Canine Fibrin Degradation Products

The cross-reactivity of the anti-human D-dimer antibody 1C9-6F10 to the canine D-dimer was evaluated by western blotting using purified canine fibrinogen, fibrin degradation products (XDPs) and plasma from a dog with suspected disseminated intravascular coagulation (DIC). The antibody cross-reacted with canine XDPs and plasma from the dog with suspected DIC. A latex agglutination assay using 1C9-6F10 measured the canine XDPs in dogs. In conclusion, the antibody 1C9-6F10 cross-reacted to the canine D-fragment with high specificity, but lower affinity compared with the human D-dimer. The latex agglutination assay using the 1C9-6F10 antibody was used to measure canine plasma D-dimer concentrations.

Aqueous humor fibrinolytic activity in dogs with cataracts

To investigate fibrinolytic activity in aqueous humor (AH) of healthy and sick dogs, with and without cataracts. Prospective observational clinical study. A total of 45 dogs were included in the study. Physical and ophthalmic examinations, complete blood cell count (CBC) and serum biochemistry panel were performed in all animals. According to the ocular and systemic diagnoses, animals were classified into three groups: sick dogs without cataracts (20 dogs; 40 eyes), diabetic dogs with cataracts (11 dogs; 22 eyes), and healthy dogs with cataracts (14 dogs; 25 eyes). Bilateral AH and blood samples were collected during intraocular surgery (25 dogs; 47 eyes), or immediately after euthanasia (20 dogs; 40 eyes). Citrated samples were centrifuged and stored at -81 °C until analysis. Plasma and AH D-dimer concentration were determined using a quantitative immunoturbidimetric latex agglutination assay. A total of 108 canine samples (45 plasma and 87 AH samples) were obtained. D-dimer concentration in log-scale, in AH of eyes with diabetic cataract was significantly higher than AH of eyes with nondiabetic cataract, with a difference of 0.9 ng/mL 95% confidence interval (CI) (0.2; 1.6) P = 0.0116 and higher than that of sick animals with healthy eyes, with a estimated difference of -0.89 ng/mL 95% CI (-1.52; -0.25) P = 0.0061. Plasma D-dimer concentration was significantly higher in the group of animals with systemic disease [median 606 ng/mL, Interquartil Range (IQR) 145-1956 ng/mL] than in healthy dogs (median 47.5 ng/mL, IQR 4-250 ng/mL) (P = 0.002) and diabetic dogs (median 60.5 ng/mL, IQR 0-147.5 ng/mL) (P < 0.001). AH fibrinolysis is present in dogs, being significantly higher in animals with diabetic cataracts than in those without cataracts, and those with nondiabetic cataracts.

Plasma D-dimer changes and prognostic implication in severe acute pancreatitis

To study the role of plasma D-dimer in human severe acute pancreatitis (SAP) and its relationship with disease severity. A prospective study was performed. From February 2010 to June 2011, plasma concentration of D-dimer and the results of other routine laboratory tests were measured in 32 SAP inpatients at admission immediately and 24, 48, 72 hours after admission. Ranson scores were also recorded. The relationship between plasma concentration of D-dimer and the results of other routine laboratory tests, Ranson scores were analyzed, and so did the relationship between plasma concentration of D-dimer and severity of patient's condition. (1) There were no obvious changes for plasma concentration of D-dimer and the results of other routine laboratory index in 32 SAP inpatients at each time points after admission. (2) Plasma concentration of D-dimer of SAP was positively related to white blood count (WBC), creatinine (Cr), prothrombin time (PT) and activated partial thromboplastin time (APTT) and negatively related to hematocrit (Hct), albumin and calcium (P<0.05 or P<0.01). Plasma concentration of D-dimer of SAP at 48 hours after admission had positive relationship with Ranson scores (r=0.729, P=0.001). (3) Plasma concentration of D-dimer of SAP inpatients in CT grade D, E stage were significantly higher than that in CT grade B, C stage (1.18±0.02 mg/L, 1.23±0.01 mg/L vs. 0.90±0.02 mg/L, 0.93±0.01 mg/L, all P<0.05). (4) Plasma concentration of D-dimer of SAP in inpatients with multiple organ failure (MOF) at 24 hours and 48 hours were significantly higher than that in inpatients without MOF (24 hours: 1.26±0.02 mg/L vs. 0.93±0.02 mg/L, 48 hours:1.25±0.02 mg/L vs. 0.93±0.02 mg/L, both P<0.05). Plasma concentration of the D-dimer is significantly increased in SAP patients, and is related to the severity. The first plasma concentration of D-dimer of SAP after admission can well reflect severity of patient's condition.

Evaluation of inflammatory and hemostatic surgical stress responses in male cats after castration under general anesthesia with or without local anesthesia

To characterize acute inflammatory and hemostatic surgical stress responses following castration in cats and to evaluate whether the addition of local anesthesia to the anesthetic protocol attenuates these responses. 39 male cats. Cats undergoing castration were randomly assigned to 2 groups: both groups underwent surgery with general anesthesia, and 1 group additionally received a local anesthetic (lidocaine [2.0 mg/kg in total, divided intratesticularly and SC]) prior to incision. Blood samples were collected after anesthetic induction (baseline) and 1, 5, and 24 hours later. Thromboelastography and coagulation variables (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) were analyzed; fibrinolysis was assessed with plasma D-dimer concentrations. The acute-phase response was evaluated via measurement of plasma fibrinogen and serum amyloid A (last time point, 28 hours) concentrations. Hematologic variables were analyzed at baseline and 1, 5, and 24 hours later. Evidence of hemostatic and inflammatory activation after surgery was detected in both groups. Maximum amplitude and G (global clot strength) were significantly increased at 24 hours, and significant, but not clinically relevant, decreases were detected in aPTT at 5 and 24 hours and in PT at 24 hours, compared with baseline values. Serum amyloid A concentrations were significantly higher at 24 and 28 hours than at baseline, and plasma fibrinogen concentration was significantly increased at 24 hours; WBC and RBC counts and Hct were significantly increased at multiple time points. No differences between groups were detected for any variables. Castration appeared to induce hypercoagulability and an acute-phase inflammatory response in cats. Local anesthesia with lidocaine did not attenuate this response.

Elevated preoperative plasma D-dimer levels and the incidence of venous thromboembolism in Japanese females with gynecological cancer.

The purpose of the present study was to determine the incidence of increased levels of D-dimer and associated factors in preoperative patients with gynecological cancer. Furthermore, we determined the incidence and risk factors associated with preoperative venous thromboembolism (VTE). Overall, 456 patients with invasive gynecological cancer scheduled to undergo surgery were recruited. Preoperative plasma D-dimer levels were measured and patients whose plasma D-dimer concentration exceeded the pre-set cut-off value underwent computed tomography scanning. The incidence of elevated D-dimer and VTE was identified as significantly higher in patients with ovarian cancer. Multivariate analysis revealed that advanced age, low hemoglobin levels and elevated C-reactive protein (CRP) levels were independent factors for preoperative elevations in plasma D-dimer levels. Advanced age was an independent risk factor for preoperative VTE. Massive ascites and the presence of co-morbidities were independent risk factors for preoperative VTE in ovarian cancer. Advanced age and stage were independent risk factors for preoperative VTE in endometrial cancer. Advanced age was an independent risk factor for preoperative VTE in cervical cancer. Plasma D-dimer levels and the incidence of preoperative VTE were higher in patients with ovarian cancer compared with those with other gynecological cancers. Advanced age, low hemoglobin levels and elevated CRP levels were significant factors associated with elevated plasma D-dimer levels and age was an independent risk factor for preoperative VTE in gynecological cancer.

Prognostic Value of Plasma Concentration of D-dimer on Admission for In-hospital Mortality in Patients Hospitalized for Worsening Heart Failure

Prognostic Value of Plasma Concentration of D-dimer on Admission for In-hospital Mortality in Patients Hospitalized for Worsening Heart Failure

High-Altitude Pulmonary Edema Is Associated With Coagulation and Fibrinolytic Abnormalities

ObjectivesHigh-altitude pulmonary edema (HAPE) can develop in unacclimatized persons after acute ascent to high altitude and is associated with fibrinolytic and coagulation abnormalities. The authors investigated whether fibrinolytic and coagulation abnormalities were associated with the severity of HAPE. MethodsSixty-one patients who developed HAPE after acute ascent to altitudes above 3600m were recruited. Twenty unacclimatized controls who acutely ascended to the same altitude and 20 acclimatized inhabitants served as controls. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) levels were measured using chromogenic substrate assays. Plasma fibrinogen concentration was determined by the sodium sulphite fractionation method. The concentrations of fibrin/fibrinogen degradation products (FDP) and D-dimer were measured by enzyme linked immunosorbent assay. ResultsThe plasma concentrations of D-dimer, fibrinogen, FDP and t-PA and PAI-1 were significantly higher in patients with HAPE than controls. In addition, these abnormalities were correlated with the severity of HAPE. The plasma concentrations of D-dimer and fibrinogen recovered to normal upon recovery from HAPE while t-PA, PAI-1 and FDP levels in HAPE patients still remained significantly increased over those of unacclimatized controls. ConclusionThe development of HAPE is associated with abnormalities in the fibrinolysis and coagulation system, and these abnormalities correlate with the severity of HAPE.

Haemostatic and inflammatory responses to blood flow‐restricted exercise in patients with ischaemic heart disease: a pilot study

Low-intensity resistance exercise can effectively induce muscle hypertrophy and increases in strength when combined with moderate blood flow restriction (BFR). As this type of exercise does not require lifting heavy weights, it might be a feasible method of cardiac rehabilitation, in which resistance exercise has been recommended to be included. Although previous studies with healthy subjects showed relative safety of BFR exercise, we cannot exclude the possibility of unfavourable effects in patients with cardiovascular disease. We therefore aimed to investigate haemostatic and inflammatory responses to BFR exercise in patients with ischaemic heart disease (IHD). Nine stable patients with IHD who were not taking anticoagulant drugs performed four sets of knee extension exercise at an intensity of 20% one-repetition maximum (1RM) either with or without BFR. Blood samples were taken before, immediately after and 1 h after the exercise session and analysed for noradrenaline, D-dimer, fibrinogen/fibrin degradation products (FDP) and high-sensitive C-reactive protein (hsCRP). Plasma noradrenaline concentration increased after the exercise, and the increase was significantly larger after the exercise with BFR than without BFR. On the other hand, increases in concentrations of plasma D-dimer and serum hsCRP were independent of the condition. However, increases in D-dimer and hsCRP were no longer observed after plasma volume correction, suggesting that hemoconcentration was responsible for these increases. Plasma FDP concentration did not change after the exercise. These results suggest that applying BFR during low-intensity resistance exercise does not affect exercise-induced haemostatic and inflammatory responses in stable IHD patients.

Influence of mechanical hemolysis of blood on two D-dimer immunoassays

Although there is broad information about the influence of spurious hemolysis on several laboratory tests, less is known on the bias produced on D-dimer testing. Four different pools were obtained from primary blood tubes, and each of them was divided into four aliquots. The first nonhemolyzed was centrifuged, the plasma was separated and then tested for hemolysis index and D-dimer. The second (hemolyzed aliquot A), third (hemolyzed aliquot B) and fourth (hemolyzed aliquot C) aliquots were mechanically hemolyzed by aspirating whole blood one, two and three times through a fine needle. The plasma was then separated and tested for hemolysis index and D-dimer. D-dimer was quantified by HemosIL AcuStar D-dimer and HemosIL D-dimer HS for ACL TOP. Undetectable hemolysis was present in aliquot nonhemolyzed (<0.5 g/l), whereas the concentration of cell-free hemoglobin significantly increased from hemolyzed aliquot A (5.5-7.0 g/l hemoglobin) to hemolyzed aliquot B (11.5 and 15.0 g/l hemoglobin) and hemolyzed aliquot C (20-22 g/l hemoglobin). The plasma concentration of D-dimer decreased from aliquots nonhemolyzed to hemolyzed aliquot C, achieving clinical significance fromhemolyzed aliquot A and hemolyzed aliquot B when measured with D-dimer HS for ACL TOP and AcuStar D-dimer, respectively. The decrease with AcuStar D-dimer was -5 ± 3% in hemolyzed aliquot A, -7 ± 3% in hemolyzed aliquot B, and -9 ± 3% in hemolyzed aliquot C, whereas the decrease with D-dimer HS for ACL TOP was -5 ± 3% in hemolyzed aliquot A, -8 ± 3% in hemolyzed aliquot B and -9 ± 3% in hemolyzed aliquot C. The similar trend towards decreasing values observed when measuring D-dimer with chemiluminescent and turbidimetric immmunoassays on four heterogeneous plasma pools suggest that the hemolysis interference is more likely to be biological than analytical. The modest bias observed in samples with frank hemolysis (i.e. cell-free hemoglobin of 11.5 g/l) confirms that both methods are robust against this type of interference, so that test results might be released in the majority of mildly hemolyzed samples.