Interpretation erhöhter D-Dimerkonzentration

Zusammenfassung

Hintergrund: Die Bestimmung der D-Dimerkonzentration ist unverzichtbarer Bestandteil der Diagnostik thromboembolischer Erkrankungen (z. B. Beinvenenthrombosen, Lungenembolien). D-Dimere sind als Spaltprodukte des Fibrins bei fibrinolytischen Prozessen im Rahmen der reaktiven Fibrinolyse nach thrombotischen Prozessen nachweisbar. Fragestellung: In der klinischen Praxis bestehen immer wieder Probleme bei der Interpretation erhöhter D-Dimerkonzentrationen, vor allem, wenn keine thromboembolische Erkrankung vorliegt. Vor der Einleitung einer weiterführenden (meist bildgebenden) Diagnostik sollen andere Ursachen für die erhöhten D-Dimerwerte (z. B. Schwangerschaft, Tumorerkrankung, systemische entzündliche Erkrankung, fortgeschrittene Arteriosklerose) differenzialdiagnostisch berücksichtigt werden. Zusammenfassung: Die Bestimmung des D-Dimerkonzentration muss zielgerichtet bei thromboembolischen Erkrankungen erfolgen. Der Parameter ist jedoch ungeeignet als Screening-Verfahren im Rahmen der klinischen Routine. Gesichert ist sein hoher prädiktiv-negativer Wert zum Ausschluss einer Thrombose bzw. Lungenembolie bei negativem Testergebnis. Zahlreiche weitere Erkrankungen oder physiologische Zustände führen ebenfalls zu erhöhter D-Dimerkonzentration, so dass ein positiver D-Dimer-Test nicht die Basis zur Diagnose einer Thromboembolie sein darf.

Summary

Background: The determination of D-dimer concentration is an essential part in the diagnostic procedure of thromboembolic diseases, e. g. deep vein thrombosis, pulmonary embolism. D-dimers are the products of fibrin hydrolysis with elevated levels in fibrinolytic processes. Question: In the clinical practice problems exist in the interpretation of increased D-dimer concentrations, especially without thromboembolic disease. Before starting further expensive imaging diagnostics other reasons (i. e. pregnancy, neoplasma, systemic inflammatory disease, advanced arteriosclerosis) should be considered in differential diagnosis. Conclusion: The determination of the concentration of D-dimers is involved in the diagnostic strategy in thromboembolic diseases. However, this parameter is not suited for routine screening. Its high predictive-negative value is proved for the exclusion of thrombosis or pulmonary embolism in case of negative test result. Since a range of diseases and physiological conditions lead to increased D-dimer values, a positive D-dimer result does not verify the diagnosis of thromboembolism.

Schlüsselwörter

D-Dimer - Thromboembolie - Hämostasestörung

Keywords

D-dimer - thromboembolic disease - coagulation disorder

• Literatur

• 1 Antovic J, Bakie M, Zivkovic M. et al. Blood coagulation and fibrinolysis in acute ischaemic and haemorrhagic (intracerebral and subarachnoidal haemorrhage) stroke: does decreased plasmin inhibitor indicate increased fibrinolysis in subarachnoid haemorrhage compared to other types of stroke?. Scand J Clin Lab Invest 2002; 195-9.
• 2 Bartels M. Fibrinolyse. In: Bartels M, Poliwoda H. (Hrsg). Gerinnungsanalysen. Stuttgart New York: Thieme; 1997: 18-20.
• 3 Blackwell K, Haroon Z, Broadwater G. et al. Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status. Clin Oncol 2000; 600-8.
• 4 Bloom B, Tucker L, Miller L. et al. Fibrin D-dimer as a marker of activity in systemic onset juvenile rheumatoid arthritis. J Rheumatol 1998; 1620-5.
• 5 Brill-Edwards P, Lee A. D-dimer testing in the diagnosis of acute venous thromboembolism. Thromb Haemost 1999; 688-94.
• 6 Danesh J, Whincup P, Walker M. et al. Fibrin D-dimer and coronary heart disease: prospective study and meta-analysis. Circulation 2001; 2323-7.
• 7 Dempfle C. Use of D-dimer assays in the diagnosis of venous thrombosis. Semin Thromb Hemost 2000; 631-41.
• 8 Ferrigno D, Buccheri G, Ricca I. Prognostic significance of blood coagulation tests in lung cancer. Eur Respir J 2001; 667-73.
• 9 Garcia-Fernandez N, Montes R, Purroy A. et al. Hemostatic disturbances with systemic inflammatory syndrome (SIRS) and associated acut renal failure. Thromb Res 2000; 19-25.
• 10 Goldstein N, Kollef M, Ward S. et al. The impact of the introduction of a rapid D-dimer assay on the diagnostic evaluation of suspected pulmonary embolism. Arch Intern Med 2001; 567-71.
• 11 Girndt M, Ulrich C, Kaul H. et al. Uremia-associated immune defect: the IL-10-CRP axis. Kidney International 2003; 76-9.
• 12 Guo L, Wang B, Xiao L. Clinical study of fibrinolysis indicators in patients with chronic pulmonary heart disease. Zhonghua Jie He He Hu Xi Za Zhi 1999; 22.
• 13 Hayat M, Ariens R, Moayyedi P. et al. Coagulation factor XIII and the markers of thrombin generation and fibrinolysis in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2002; 249-56.
• 14 Horan J, Francis C, Falsey A. et al. Prothrombotic changes in hemostatic parameters and C-reactive protein in the elderly with winter acute respiratory tract infections. Thromb Haemost 2001; 245-9.
• 15 Lowe G, Yarnell J, Rumley A. et al. C-reative protein, fibrin D-dimer, and incident ischemic heart disease in the Spedwell study: are inflammation and fibrin turnover linked in pathogenesis?. Arterioscler Thromb Vasc Biol 2001; 603-10.
• 16 Mammen E. Disseminated intravascular coagulation (DIC). Clin Lab Sci 2000; 239-45.
• 17 Martinez-Ramos C, Lopez-Pastor A, Nunez-Pena J. et al. Changes in hemostasis after laparoscopic cholecystectomy. Surg Endosc 1999; 476-9.
• 18 Paniccia R, Prisco D, Bandinelli B. et al. Plasma and serum levels of D-dimer and their correlations with other hemostatic parameters in pregnancy. Thromb Res 2002; 257-62.
• 19 Pavey S, Hawson G, Marsh N. Alterations to the fibrinolytic enzyme system in patients with non-small cell lung carzinoma. Blood Coagul Fibrinolysis 1999; 261-7.
• 20 Prisco D, Antonucci E, Marcucci R. et al. D-dimer in the year 2000: current data and new perspectives. Ann Ital Med Int 2000; 267-72.
• 21 Shlipak M, Fried L, Crump C. et al. Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 2993 87-92.
• 22 Tataru M, Henrich J, Junker R. et al. D-Dimers in relation to severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction. Eur Heart J 1999; 1493-502.