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CC BY 4.0 · TH Open 2020; 04(03): e178-e188
DOI: 10.1055/s-0040-1714210
Original Article

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

Maria Farm
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2   Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
,
Aleksandra Antovic
3   Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
4   Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
,
David E. Schmidt
5   Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
6   Coagulation Unit, Division of Haematology, Karolinska University Hospital, Stockholm, Sweden
,
Niklas Bark
2   Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
,
Nida Soutari
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2   Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
,
Anwar J. Siddiqui
7   Emergency Medicine Function, Karolinska University Hospital, Stockholm, Sweden
,
Margareta Holmström
8   Division of Diagnostics and Specialist Medicine, Unit of Internal Medicine, Medicine and Caring Sciences, Department of Health, Linköping University, Linköping, Sweden
,
Iva Pruner
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
,
Jovan P. Antovic
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2   Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
› Author Affiliations Funding This study was supported by the Foundation for Coagulation Research at Karolinska Institutet, the Scandinavian Research Foundation for Varicose Veins and other Venous Diseases, FoU Region Stockholm, the Swedish Society on Thrombosis and Haemostasis with Leo Pharma.
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Abstract

Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE.

Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE.

Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records.

Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay.

Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.

Keywords

predictive value of tests - global hemostatic assays - clinical studies - deep vein thromboses - pulmonary embolism

Supplementary Material



Publication History

Received: 05 February 2020

Accepted: 09 June 2020

Article published online:
20 August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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