Plasma Fibrin Degradation Products Research Articles

Hematological disorders as a complication of COVID-19

Background. Coronavirus disease (COVID-19) can affect the blood and hemostasis systems and lead to complications that require intensive care. The aim is to detect such common complications by studying literary sources and clinical experience. Materials and methods. The search for relevant literature was conducted in PubMed, and in the other databases such as Science Direct, Google Scholar, Scopus and Web of Science. The literature search was done using the keywords “COVID-19”, “SARS-CoV-2” in combination with “coagulation dysfunction”, “coagulopathy”, “hematological manifestations”, “hematological parameters”, “deep vein thrombosis”, “pulmonary embolism”, “arterial thrombosis”, “D-dimer”, “fibrinogen”, “lymphopenia”, “thrombocytopenia”. Results. COVID-19-associated coagulopathy is characterized by high levels of D-dimer and fibrin degradation products in blood plasma, changes in prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count. Endothelial dysfunction caused by coronavirus leads to an increased risk of thrombotic complications, both in venous and arterial systems, additionally to the existing higher risk of thrombosis in the intensive care unit. The venous thromboembolism frequency among unvaccinated hospitalized patients and during ultrasound screening is significantly higher. Coronavirus disease can lead to arterial thrombosis in areas such as the aorta, kidneys, cerebral and peripheral arteries. COVID-19 can cause enhanced-fibrinolytic-type disseminated intravascular coagulation or limited thrombotic microangiopathy. According to research, patients with severe COVID-19 usually had leukocytosis, lymphopenia, and an elevated neutrophil-to-lymphocyte ratio. Thrombocytopenia is observed not only during the acute coronavirus disease, but also in the post-COVID-19 period. Both thrombosis and bleeding can occur in patients undergoing extracorporeal membrane oxygenation. Conclusions. A high level of D-dimer, a prolongation of prothrombin time, an increase or a quick decrease in fibrinogen level, lymphopenia, neutrophilia, and an increase in the neutrophil-to-lymphocyte ratio are considered prognostic factors for the severity of coronavirus disease. Deep vein thrombosis and pulmonary embolism are the most common thrombotic events in patients with COVID-19. Arterial thrombosis occurs more often in the cerebral arteries and arteries of the extremities.

Robust coagulation activation and coagulopathy in mice with experimental acetaminophen-induced liver failure

BackgroundPatients with acetaminophen (APAP)-induced acute liver failure (ALF) display both hyper- and hypocoagulable changes not necessarily recapitulated by standard hepatotoxic doses of APAP used in mice (eg, 300 mg/kg). ObjectivesWe sought to examine coagulation activation in vivo and plasma coagulation potential ex vivo in experimental settings of APAP-induced hepatotoxicity and repair (300-450 mg/kg) and APAP-induced ALF (600 mg/kg) in mice. ResultsAPAP-induced ALF was associated with increased plasma thrombin–antithrombin complexes, decreased plasma prothrombin, and a dramatic reduction in plasma fibrinogen compared with lower APAP doses. Hepatic fibrin(ogen) deposits increased independent of APAP dose, whereas plasma fibrin(ogen) degradation products markedly increased in mice with experimental ALF. Early pharmacologic anticoagulation (+2 hours after 600 mg/kg APAP) limited coagulation activation and reduced hepatic necrosis. The marked coagulation activation evident in mice with APAP-induced ALF was associated with a coagulopathy detectable ex vivo in plasma. Specifically, prolongation of the prothrombin time and inhibition of tissue factor–initiated clot formation were evident even after restoration of physiological fibrinogen concentrations. Plasma endogenous thrombin potential was similarly reduced at all APAP doses. Interestingly, in the presence of ample fibrinogen, ∼10 times more thrombin was required to clot plasma from mice with APAP-induced ALF compared with plasma from mice with simple hepatotoxicity. ConclusionThe results indicate that robust pathologic coagulation cascade activation in vivo and suppressed coagulation ex vivo are evident in mice with APAP-induced ALF. This unique experimental setting may fill an unmet need as a model to uncover mechanistic aspects of the complex coagulopathy of ALF.

Hypercoagulability in women with adenomyosis who experience heavy menstrual bleeding

ObjectivesTo investigate whether there is any difference in coagulability between patients with adenomyosis-associated heavy menstrual bleeding (ADM-HMB) and women without adenomyosis. Methods and materialsSeventy-two premenopausal patients with histologically diagnosed adenomyosis, but free of metabolic or hematological diseases, who experienced either moderate/heavy menses (MHB) or excessive (EXB) menstrual blood loss (MBL) based on their amount of MBL (>60mL but ≤100mL vs. >100mL) were recruited. Additionally, 50 patients without adenomyosis were also recruited. Their demographic, clinical and coagulation information were collected. All recruited subjects had platelet count, prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (aPTT), and plasma fibrinogen and D-dimer levels. AMD-HMB patients also had data on anti-thrombin activity and fibrin degradation products (FDPs). ResultsADM-HMB patients had significantly higher platelet count, fibrinogen and D-dimer levels but shorter PT and aPTT as compared with women without adenomyosis. Within the ADM-HMB patients, patients who complained of EXB had significantly higher plasma D-dimer and FDP levels but shorter aPTT and lower fibrinogen levels than those who complained of MHB. ConclusionThese data strongly suggest that ADM-HMB women are in a hypercoagulable state as compared with women without adenomyosis, especially in those complained of excessive MBL. Our findings suggest that precautionary or even prophylactic measures may be advised to reduce the risk of thrombotic events in ADM-HMB patients, especially those with excessive MBL. In addition, our data suggest that anti-thrombotic/anti-coagulation therapies may hold therapeutic potentials.

Plasma levels of D-dimer and fibrin degradation products correlate with bullous pemphigoid severity: a cross-sectional study

Bullous pemphigoid (BP), the most frequent blistering dermatosis in the elderly, is associated with increased mortality. The severity of BP can be assessed by detecting the anti-BP180 immunoglobulin G (IgG) concentration, but the lab test is not available in many community clinics. BP patients are usually in a hypercoagulable state with increased levels of D-dimer and fibrin degradation products (FDPs). We aimed to evaluate the use of D-dimer and FDPs in assessing BP severity. We compared the levels of plasma D-dimer, plasma FDPs, eosinophil counts, eosinophil cationic protein, and serum anti-BP180 IgG concentration between 48 typical BP patients and 33 Herpes zoster (HZ) patients (control group). Correlational analyses were conducted to determine the relationships between the lab values and common BP severity markers. The plasma D-dimer and FDP levels were higher in BP patients than in HZ controls (D-dimer: 3297 ± 2517 µg/L vs. 569.70 ± 412.40 µg/L; FDP: 9.74 ± 5.88 mg/L vs. 2.02 ± 1.69 mg/L, respectively, P < 0.0001). Significant positive correlations were found between D-dimer/FDP levels and BP severity markers (i.e. anti-BP180 IgG concentration [D-dimer: r = 0.3928, P = 0.0058; FDP: r = 0.4379, P = 0.0019] and eosinophil counts [D-dimer: r = 0.3625, P = 0.0013; FDP: r = 0.2880, P = 0.0472]) in BP patients. We also found an association between FDP and urticaria/erythema lesions (r = 0.3016, P = 0.0372), but no other BPDAI components. In 19 BP patients with complete remission after systemic glucocorticoid treatment, D-dimer and FDP levels decreased post-therapy (D-dimer: 5559 ± 7492 µg/L vs. 1738 ± 1478 µg/L; P < 0.0001; FDP: 11.20 ± 5.88 mg/L vs. 5.13 ± 3.44 mg/L; P = 0.0003), whereas they did not in BP patients with treatment resistant. Plasma D-dimer and FDP are convenient markers to evaluate BP severity assistant on BPDAI and eosinophil counts. FDP is also helpful for inflammatory lesions in BP patients.

Plasma fibrinogen, d-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis

This study aimed to assess the association of coagulation-related indicators such as plasma fibrinogen (FIB), d-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) with the disease activity. Data from 105 RA patients and 102 age- and gender-matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide RA patients into low activity group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). Receiver operating characteristic (ROC) curve was applied to determine area under the curve (AUC). The association between plasma FIB, d-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Logistical regression analysis was used to identify the independent variables associated with RA disease activity. RA patients showed higher levels of plasma FIB, d-dimer, and FDP than the controls (P < 0.01). Plasma FIB, d-dimer, and FDP were also increased in active groups of RA patients than those in inactive groups (P < 0.001). ROC curve analyses revealed that the AUC of d-dimer was higher than erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), and that of FDP was higher than RF in RA patients. In addition, the optimal cut-off value of plasma FIB, d-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Spearman analysis showed that plasma FIB, d-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. Logistical regression analysis showed that d-dimer (odds ratio 2.862, 95% confidence interval 1.851–5.426, P < 0.001) was an independent variable associated with RA disease activity. FIB, d-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. d-dimer may act as a novel inflammatory indice for indicating disease activity in RA patients.

Postburn Elevation in Fibrin Degradation Product is Related to Burn Severity

Background: Burn is reported to cause significant alteration of haemocoagulativeparameters, but due to lack of proper understanding of burn coagulopathy, only theroutine coagulation tests are generally used, even though these provide limiteddiagnostic or prognostic information about burns and postburn complications. So,this study specifically aimed to characterize the changes in plasma FibrinDegradation Product (FDP) together with routine coagulative parameters and theirrelations with burn-severity.&#x0D; Materials and methods: This cross-sectional comparative study was carried out inthe Department of Biochemistry and Department of Burn and Plastic Surgery ofChattogram Medical College Hospital from January to December in 2014. 130subjects of 18 – 65 years enrolled in two groups by nonprobability consecutivesampling. Group-A consisted of 80 patients with minor, moderate and major burnsas per American Burn Association severity classification, whereas Group-B included50 age and sex-matched healthy subjects. Plasma FDP was estimated by immunoturbidimetricmethod in STA compact automated analyser. Bleeding Time (BT),Clotting Time (CT) and Prothrombin Time (PT) were also determined using standardmethods.&#x0D; Results: Burn patients had significantly higher mean FDP (10.13 ± 5.63 μg/ml) thancontrols (2.50 ± 1.56 μg/ml) which increased with increase in burn-severity (4.83,8.12 and 15.48 μg/ml in minor, moderate and major burns respectively). PlasmaFDP increased in 91.25% burn patients. While BT and CT were mostly unchanged, PTwas prolonged in 66.25% burn patients (Mean = 15 seconds) but that did not seemto correlate with burn-severity or with FDP.Conclusion: Plasma FDP increased significantly in burn patients showing better andconsistent correlation with burn-severity than routine coagulation parameters.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 43-46

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

BackgroundThe purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI).MethodsA systematic search and screening of relevant studies was performed in the databases PubMed, Web of Science, and Embase using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Data were subsequently analysed and processed using Meta-Disc.ResultsSeven studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.75 (95% confidence interval [CI] 0.70–0.79), 0.69 (95% CI 0.66–0.72), 3.01 (95% CI 1.84–4.93), 0.32 (95% CI 0.19–0.53), and 10.20 (95% CI 3.63–28.64), respectively. Subgroup analyses showed that the use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI.ConclusionsSerum D-dimer was shown to have a better diagnostic value than plasma D-dimer for the diagnosis of PJI. Further research is required for clarification.

Plasma Fibrinogen Performs Better Than Plasma d-Dimer and Fibrin Degradation Product in the Diagnosis of Periprosthetic Joint Infection and Determination of Reimplantation Timing

BackgroundThe accurate and timely diagnosis of periprosthetic joint infection (PJI) is challenging, and no single biomarker can definitively confirm infection before revision arthroplasty. The coagulation cascade has been linked closely to infection. This study was performed to determine the value of plasma d-dimer, plasma fibrinogen, and plasma fibrin degradation product (FDP) for the diagnosis of PJI and timing of reimplantation. MethodsWe retrospectively enrolled 136 patients who underwent revision surgery from January 2008 to December 2019. They were assigned to 3 groups: aseptic failure (group A), PJI (group B), and reimplantation (group C). Receiver operating characteristic curves were constructed to estimate the value of plasma fibrinogen, plasma d-dimer, plasma FDP, erythrocyte sedimentation rate (ESR), and serum C-reactive protein (CRP) for PJI diagnosis and reimplantation timing. ResultsAll biomarker levels were significantly higher in group B than in group A (P < .05), and plasma fibrinogen, CRP, and ESR values were significantly higher in group B than in group C (all P < .05). The receiver operating characteristic curves showed that the areas under the curve of plasma fibrinogen, plasma d-dimer, plasma FDP, CRP, and ESR were 0.848, 0.914, 0.728, 0.737, and 0.868, respectively, and the threshold values for plasma fibrinogen, plasma d-dimer, and plasma FDP were 3.61 g/L, 0.41 mg/L, and 3.55 mg/L, respectively. ConclusionPlasma fibrinogen exhibits good value for the diagnosis of PJI and can be an indicator of residual infection before reimplantation in 2-stage arthroplasty. Plasma d-dimer and FDP are of limited value for PJI diagnosis and cannot be used to determine the timing of reimplantation.

Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection

BackgroundAlthough the Musculoskeletal Infection Society introduced the use of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as inflammatory markers for diagnosing periprosthetic joint infection (PJI), no single blood marker reliably detects infection before revision arthroplasty. We therefore posed 2 questions: (1) Are fibrin degradation product (FDP) and D-dimer of value for diagnosing PJI before revision arthroplasty? (2) What are their sensitivity and specificity for that purpose? MethodsTo answer these questions, we retrospectively enrolled 318 patients (129 with PJI [group A], 189 with aseptic mechanical failure [group B]) who underwent revision arthroplasty during 2013-2018. Receiver operating characteristic curves were used to determine maximum sensitivity and specificity of the 2 markers. Inflammatory and fibrinolytic markers were evaluated based on (1) the Tsukayama-type infection present and (2) the 3 most common PJI-related pathogens. ResultsFDP and D-dimer levels were higher in group A than in group B: 4.97 ± 2.83 vs 4.14 ± 2.67 mg/L and 2.14 ± 2.01 vs 1.51 ± 1.37 mg/L fibrinogen equivalent units (FEU), respectively (both P < .05). Based on the Youden index, 2.95 mg/L and 1.02 mg/L FEU are the optimal FDP and D-dimer predictive cutoffs, respectively, for diagnosing PJI. Sensitivity and specificity, respectively, were 65.12% and 60.33% (FDP) and 68.29% and 50.70% (D-dimer). ESR, CRP, and interleukin-6 values were diagnostically superior to those of FDP and D-dimer. ConclusionThe value of plasma FDP and D-dimer for diagnosing PJI is limited compared with traditional inflammatory markers (ESR, CRP, interleukin-6) before revision arthroplasty.

Further Evidence for Hypercoagulability in Women With Ovarian Endometriomas.

Our previous studies have shown that platelets play a crucial role in the development of endometriosis, and women with endometriosis appear to be in a state of hypercoagulability. However, a recent study could only replicate part of our previous finding, casting doubts on this notion. We further investigated this question through a cross-sectional study by measuring additional coagulation factors in women with and without endometriosis. To this end, we conducted a cross-sectional study of 100 women with laparoscopically and pathologically diagnosed ovarian endometriomas (OMA) and another 100 women without endometriosis. The platelet count; platelet activation rate; maximum platelet aggregation rate; plasma levels of D-dimer, fibrinogen, fibrin degradation products (FDPs), plasma soluble P-selectin (sP-sel), and prothrombin fragment 1+2 (F1+2); prothrombin time; thrombin time (TT); and activated partial thromboplastin time were measured before surgery and 3 months after surgery, and their clinical data were recorded. These measurements were also performed in control patients. We found that, compared with controls, women with OMA had a significantly higher platelet activation rate and platelet aggregation rate, elevated plasma D-dimer, fibrinogen, FDPs, sP-sel, and F1+2 levels as well as shortened TT. Remarkably, TT was prolonged, and all the other coagulation measurements, except plasma fibrinogen level, were significantly reduced 3 months after surgical removal of endometriotic lesions. Thus, our study provides another piece of evidence that endometriosis is a hypercoagulable disease, and anticoagulation therapy may hold promises in treating endometriosis.

Application of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma

Objective To investigate the feasibility and clinical effect of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma. Methods A randomized, placebo controlled trial was carried out on 77 craniocerebral trauma patients [Glasgow Coma Scale (GCS) ≤12 points] enrolled between May 2015 and December 2016. There were 45 males and 32 females, with an average age of 36.5 years (range, 19-73 years). Among the patients, 37 cases were caused by traffic accidents, 19 falling from high places, 11 falling when walking, and ten by being hit. According to the random number table method, they were divided into control group (39 cases) and treatment group (38 cases). The treatment group received 1 g of tranexamic acid by intravenous injection within ten minutes on the scene and another 1 g of tranexamic acid within eight hours at the hospital. The control group received 0.9% isotonic saline. The operation and medication followed the routine process. The arrival time of ambulance and the time of first medication use were recorded. The plasma fibrin degradation products (FDP) and D-dimer at admission and 1 d post-trauma, the percentage of cranitomy operation, case fatality rate, red blood cell transfusion, length of stay in the neurosurgical intensive care unit (NICU), and the Glasgow Outcome Scale (GOS) at day 28 were all recorded and analyzed. Results No significant differences were found between the two groups in gender, age, injury causes, GCS, arrival time of ambulance, and the time of first medication use (P>0.05). The FDP and D-dimer at admission of the two groups were similar (P>0.05). One day after admission, the expression of plasma FDP was significantly lower in treatment group than that in control group [6758 (4732, 13661) μg/L vs. 11740 (8516, 21756)μg/L](P 0.05). However, treatment group showed shorter stay in NICU [4 (1, 12)days vs. 2 (0, 4)days] and higher GOS [4 (3, 5)points vs. 5 (4, 5)points]than control group (both P<0.01). Conclusions Tranexamic acid can be applied conveniently in pre-hospital emergency care of craniocerebral trauma patients. It can effectively realize the synchronization of pre hospital transport and treatment, eventually reducing the time of NICU treatment as well as improving the prognosis. Key words: Brain injuries; Tranexamic acid; Emergency medical services; Prospective studies

Fibrin-related markers for diagnosing acute-, subclinical-, and pre-venous thromboembolism in patients with major orthopedic surgery.

Venous thromboembolism (VTE) is a common complication in patients who have undergone major orthopedic surgery, but there are few predictors of VTE after major orthopedic surgery treated with an anticoagulant. We measured levels of fibrin-related markers (FRMs), such as D-dimer, soluble fibrin (SF), and fibrinogen and fibrin degradation products (FDPs) in 66 patients with acute-phase VTE, and 367 patients undergoing major orthopedic surgery. Plasma FDP, D-dimer, and SF levels were significantly higher in patients with acute VTE, but only FDP and D-dimer levels were significantly higher in subclinical VTE. Adequate cut-off levels of D-dimer were 2.2 μg/ml for diagnosing acute VTE and 1.5 μg/ml for diagnosing subclinical VTE. D-dimer of less than 1.9 or 0.7 μg/ml ruled out acute VTE or subclinical VTE. D-dimer of more than 1.3 μg/ml preoperatively showed a moderate risk for postoperative VTE. Measurement of FRMs is useful for evaluating the risk of subclinical or postoperative VTE in patients with major orthopedic surgery. In particular, FDP is the most valuable marker for diagnosing acute VTE, whereas D-dimer is the most valuable for diagnosing subclinical VTE or predicting VTE.

Plasma Fibrinogen and Fibrin Degradation Product (FDP) in Preeclamptic and Normal Pregnant Women in the Third Trimester of Pregnancy

Plasma Fibrinogen and Fibrin Degradation Product (FDP) in Preeclamptic and Normal Pregnant Women in the Third Trimester of Pregnancy

Heparin calcium treated Henoch–Schönlein purpura nephritis in children through inhibiting hyperfibrinolysis

Aim: To explore the underlying mechanism of low-molecular-weight heparin calcium therapy on Henoch–Schönlein purpura nephritis (HSPN). Methods: Eighty-nine children with severe HSPN were randomized into control group (treated with conventional therapy, n = 45) and treatment group (treated with conventional therapy plus low-molecular-weight heparin calcium, n = 44). The concentrations of plasma fibrinogen (Fg), d-dimer and fibrin degradation products (FDPs) were detected before and after treatment. The urinary red blood cell (RBC) and 24 h proteinuria were determined weekly for assessing the children’s kidney function. Results: Two groups were well-matched at baseline. After 8 weeks of treatment, the clinical outcomes of HSPN and outcome of proteinuria of the treatment group were better than the control group (p < 0.05); the content of Fg, d-dimer and FDP in plasma of the treatment group were lower than the control group (p < 0.05); but there was no difference about the curative effect of hematuria and the coagulation function between the two groups (p > 0.05). Conclusions: Fibrinolytic system may participate in the kidney injury of HSPN children and low-molecular-weight heparin calcium could correct blood hypercoagulability through inhibiting hyperfibrinolysis, and thus improving the blood supply of kidney.

Transdermal patch of bisoprolol for the treatment of hypertension complicated with aortic dissection

A 63-year-old man presented to a clinic because of sudden onset of severe longitudinal back pain and was transferred to the intensive care unit (ICU) of our hospital. He had been hypertensive for 30 years; however, he had never been referred to a clinic for treatment. Physical examination findings were unremarkable, except for high blood pressure (BP) (220/110mmHg) and heart rate (80 beats/min). Electrocardiography and chest radiography findings were normal. Blood examination showed leukocytosis (9700/μL) without an increased plasma fibrin degradation products level (2 μg/mL). The patient was diagnosed with acute type B aortic dissection (AD) with a thrombosed false lumen by enhanced computed tomography (Fig. 1). We administered an 8-mg/day transdermal patch of bisoprolol after titration of intravenous nicardipine (Fig. 2). Six hours later, systolic BP decreased to 112 mm Hg and heart rate decreased to 54 beats/min. Additionally, the ventricular force (dP/dt) of aortic pressure decreased over time. After intravenous nicardipine was withdrawn, 40 mg of olmesartan, 80 mg of nifedipine, and 2 mg of doxazosin in addition to the 8-mg transdermal patch of bisoprolol were administered, and systolic BP was well controlled to b120 mm Hg. He was discharged 23 days after the onset of AD without any complication. BP reduction is critical to preventing lethal complications, including enlargement of aortic aneurysm and aortic rupture in the acute phase [1]. dP/dt and stress on the aorta are risk factors, and therefore, β-blockers should be the first drug of choice because they have negative chronotropic and negative inotropic effects [2]. Maintaining systolic BP between 100 and 120 mm Hg with a heart rate b60 beats/min is an attainable temporal goal [3], which was achieved with intravenous nicardipine and transdermal bisoprolol in the present case. However, in many cases, multiple BP-lowering agents are required to achieve this goal. Intravenous agents should be chosen for controlling BP because of the need for titration of the dose, especially in patients with a

Abstract 261: Neutrophil Elastase Derived Fibrin Degradation Products are Increased in the Plasma of Patients with Abdominal Aortic Aneurysms and Correlate to the Intraluminal Thrombus Volume

Introduction: Abdominal Aortic Aneurysms (AAA) often contain an intraluminal thrombus (ILT). AAA diameter and ILT volume are associated with growth of the aneurysm. Neutrophils, present in the ILT, contain elastase (NE). NE activity leads to production of fibrin degradation products (FDPs) with a specific epitope [[Unable to Display Character: &amp;#8211;]] XDP. The present study evaluates NE-derived FDPs in aneurysm patients scheduled for elective aortic repair. The purpose of the study is to introduce an additional bio-marker for presence of AAA and possibly risk of rupture by measuring levels of NE derived FDPs in plasma of patients with AAA. Materials and Methods: 42 male patients, undergoing aortic repair for AAA were included. As controls, we collected blood samples from 42 men who attended an AAA screening program but had no AAAs on ultrasound. Computed Tomography (CT) images were available for 34 AAA patients and analyzed using A4 Clinics software (VASCOPS, Austria). Patient demographics, maximum diameter, aortic volume and ILT volume were recorded. Peak wall stress (PWS), peak wall rupture index (PWRI) and mean ILT stress were estimated by Finite Element Analysis using the A4 Clinics software. Plasma levels of elastase digests of cross-linked fibrin (E-XDP) were determined with a sandwich ELISA. Results: E-XDP levels were higher in AAA patients than in age-matched controls (8.5 vs 1.2 U/ml, p&lt;0.0001). E-XDP levels correlated with ILT volume (r = 0.64, p&lt;0.0001), aortic volume (r = 0.64, p&lt;0.0001) and maximum diameter (r = 0.59, p=0.0003). AAA patients with other concomitant peripheral aneurysms had higher E-XDP levels than those with only an AAA (13.6 vs 6.8 U/ml, p=0.028). PWS, PWRI and bleeding signs in the thrombus did not significantly affect E-XDP levels. Interestingly, the mean ILT stress correlated significantly to E-XDP levels (r= 0.45, p=0.008). Conclusions: The study shows that it is feasible to measure E-XDP levels in plasma of patients with AAA and that E-XDP correlates with ILT volume and mean ILT stress. These results support the notion that the resident neutrophils in the ILT can actively lyse fibrin in the ILT, which may decrease ILT strength. E-XDP holds potential as a biomarker of the ILT in AAA patients and needs to be further investigated in AAA rupture risk assessment.

A Study on Estimation of plasma Fibrinogen and plasma fibrin degradation product FDP in women with preeclamptic pregnanc

A Study on Estimation of plasma Fibrinogen and plasma fibrin degradation product FDP in women with preeclamptic pregnanc

Evaluation of plasma fibrinogen and plasma fibrin degradation product (FDP) in Preeclampsia

Background: Preeclampsia is one of the commonest complications of pregnancy. It is associated with a state of hypercoagulability. The present study aimed to estimate the plasma fibrinogen and plasma FDP levels in preeclampsia compared to normal pregnancies. Materials and Methods: This is a case-control hospital based study carried in the Department of Biochemistry M.G.M. Medical College and associated M.Y. Hospital, Indore (M.P., India). Normal pregnant women (n=36) and women with preeclampsia (n=64) in their third trimester were included in the study. Preeclamptic group was classified in to mild (n=42) and severe (n=22) preeclampsia. Plasma fibrinogen and FDP levels were analysed, and compared between the groups. Results: Preeclampsia and normal pregnancy groups were comparable for age and body mass index but preeclampsia group had higher blood pressures and less period of gestation (p<0.0001). The levels of plasma fibrinogen (654.5±131.74 vs. 491.52±81.7 mg/dL) and plasma FDP (10.96±2.32 vs. 5.54±0.8 µg/L) were higher in the preeclampsia group as compared to normal pregnancy (p<0.0001). Elevations in fibrinogen and FDP levels were more marked for severe preeclampsia group than mild preeclampsia group. Conclusion: Preeclampsia is associated with high fibrinogen and FDP levels as compared to normal pregnancies. Severe preeclampsia patients have greater elevations as compared to mild preeclampsia patients. Key words: Fibrin degradation products, Fibrinogen, pre-eclampsia.

Plasma Fibrin Degradation Products (Fdp ) In Patients With Pre Eclamptic Toxaemia (Pre-eclampsia)

Plasma fibrin degradation products (F.D.P.) assay measures the amount of fibrin split products in the blood. The high levels of F.D.P. in pre-eclampsia suggests that abnormal amount of degradation products are most likely due to localized lysis of fibrin in the uterine vascular compartment. The present case control study was designed to determine the relationship between plasma fibrin degradation products and pre-eclampsia. The study was carried out in the department of Biochemistry, Chittagong Medical College during the period of September 2011 to August 2012. The samples were collected from the department of Obstetrics and Gynecology, Chittagong Medical College Hospital, age from 18- 40 years. The data were collected by a structured questionnaire including age, socioeconomic condition, gravida, para, edema, blood pressure, proteinuria, history of hypertension, family history of pre-eclampsia and diabetes mellitus. Considering the cost of experiment and length of time, total 60 patients were included in this study. Among them 40 were considered as case (Blood Pressure &gt; or = 140/90 mm of Hg and proteinuria &gt; 0.3 gram/day) and 20 were considered as control (Blood Pressure &lt; 140/90 mm of Hg and no proteinuria). Plasma fibrin degradation products were measured in all samples. Study showed that plasma FDP were more increased in pre-eclamptic patients than that of normal pregnancy (21.52 + 16.47 ugm/ml Vs 10.63 + 7.12 ugm/ml), P = &lt;0.01. Result showed that percentage of raised plasma FDP is more in preeclamptic patients (100%) than that of normal pregnancy (75%), P= &lt;0.01. Pearson's Correlation Coefficient (r) showed that there were positive correlation between blood pressure and plasma FDP (systolic blood plessure and plasma FDP, r=0.221,P=&gt;.0.05 and diastolic blood pressure and plasma FDP, r=0.285,P=&lt;0.05). Significantly raised level of plasma F.D.P. in pre-eclampsia help to formulate a management plan and thereby reduce the complications of this disease. JCMCTA 2013; 24 (1):9-13

Distinct reactivity of the commercially available monoclonal antibodies of D-dimer and plasma FDP testing to the molecular variants of fibrin degradation products

Fibrin degradation products (FDP) are an important marker of coagulopathy. We assessed the reactivity of the monoclonal antibodies used in clinical laboratory testing (6 D-dimer reagents, D-dimer-1-6; 4 plasma FDP reagents, plasma FDP-1-4) to quantify FDP using in vitro-generated FDP as well as FDP in clinical samples. The monoclonal antibodies used in D-dimer-1, -2, -5, and -6 reacted poorly to the low molecular weight forms of in vitro-generated FDP. The monoclonal antibodies used in D-dimer-3 and -4 had better reactivity to the low molecular weight forms of in vitro-generated FDP. The monoclonal antibodies used in plasma FDP-2, -3, and -4 reacted well to the high and low molecular weight FDP forms, while the monoclonal antibody in plasma FDP-1 reacted poorly to the low molecular weight FDP forms. Analysis of clinical samples revealed deviations in FDP molecular weight forms in DIC samples. The reactivity of the monoclonal antibodies of laboratory FDP testing to FDP variants in clinical samples was similar to that of in vitro-generated FDP. In conclusion, the monoclonal antibodies used in clinical laboratories to detect FDP have distinct reactivity to the molecular variants of FDP generated in vitro as well as those present in clinical samples. Our findings support the consensus for the standardization of D-dimer and plasma FDP testing.