D-dimer, P-selectin, and microparticles: Novel markers to predict deep venous thrombosis

John E. Rectenwald; Daniel D. Myers Jr; Angela E. Hawley; Christopher Longo; Peter K. Henke; Kenneth E. Guire; Alvin H. Schmaier; Thomas W. Wakefield

doi:10.1160/TH05-06-0426

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 94(06): 1312-1317
DOI: 10.1160/TH05-06-0426

New Technologies and Diagnostic Tools

Schattauer GmbH

D-dimer, P-selectin, and microparticles: Novel markers to predict deep venous thrombosis

A pilot study

John E. Rectenwald

¹Departments of Surgery, Section of Vascular Surgery

,

Daniel D. Myers Jr

¹Departments of Surgery, Section of Vascular Surgery

,

Angela E. Hawley

¹Departments of Surgery, Section of Vascular Surgery

,

Christopher Longo

¹Departments of Surgery, Section of Vascular Surgery

,

Peter K. Henke

¹Departments of Surgery, Section of Vascular Surgery

,

Kenneth E. Guire

³School of Public Health, University of Michigan, Ann Arbor, Michigan, USA

,

Alvin H. Schmaier

²Internal Medicine and Pathology

,

Thomas W. Wakefield

¹Departments of Surgery, Section of Vascular Surgery

› Author Affiliations

Abstract

Summary

Current plasma markers for diagnosis of deep venous thrombosis (DVT) allow for exclusion of the diagnosis, but lack adequate specificity to establish the diagnosis. Thus, a prospective study was performed to determine the sensitivity and specificity of plasma assays for D-dimer, soluble P-selectin (P-selectin), and total microparticles in patients with documented DVT by duplex ultrasound. Three groups of individuals were examined: 30 normals; 22 positive for DVT on duplex ultrasound (Group 2); and 21 symptomatic, but negative on duplex ultrasound for DVT (Group 3). Group 1 individuals had D-dimer values of 1.53±0.12 mg/l and P-selectin values of 0.34±0.05 ng/mg total protein. Group 2 vs. Group 3 individuals had D-dimer values of 7.57±2.03 vs. 3.19±0.79 mg/l, p=0.02; P-selectin values of 0.98±0.11 vs. 0.55±0.08 ng/mg total protein, p<0.01; and microparticle values of 129±17% vs. 99±12% of control, p=ns. Using a logistic regression model with dichotomous variables, we determined a sensitivity of 73%, specificity of 81%, and accuracy of 77% when combining D-dimer, soluble P-selectin, and total microparticles to differentiate Group 2 from Group 3 patients. Logistic regression using continuous variables yielded similar results (p=0.05).This study demonstrates that plasma markers for DVT can be developed and achieve moderate sensitivity and specificity in diagnosing DVT. However for clinical applicability, the sensitivity/specificity will need to be improved. These studies also suggest the importance of soluble P-selectin in assessing DVT in humans.

Keywords

Deep venous thrombosis - D-dimer - P-selectin - microparticles - clinical study

Full Text

References

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