Markers of plasma coagulation and fibrinolysis after acute deep venous thrombosis

AbstractObjective: Plasma markers of coagulation and fibrinolysis have proved sensitive in the initial diagnosis of acute deep venous thrombosis (DVT). The purpose of this study was to examine the evolution and utility of measuring D-dimer and prothrombin fragment 1+2 (F 1+2) levels after an acute DVT. Methods: Subjects with DVT confirmed by ultrasonography had quantitative plasma D-dimer and F 1+2 levels determined before anticoagulation. Ultrasound scan and coagulation studies were repeated at 3, 7, and 14 days; 1 month; and every 3 months for 1 year. Results: Sixty-one patients with a median initial thrombus score of 3 (interquartile range, 2-7) were followed up for 266 days (interquartile range, 91.5-364 days). Initial D-dimer levels were elevated in 92.7% of patients and were associated with thrombus extent (P =.003), whereas F 1+2 levels were increased in 94.5% of patients and were lower in patients with isolated calf vein thrombosis (P =.001). Initial D-dimer (P =.002) and F 1+2 levels (P =.009) were significantly higher in the 26 (43%) patients with recurrent thrombosis during follow-up. Initial D-dimer levels of 2000 ng/mL or greater were predictive of recurrent events after both proximal and isolated calf vein thrombosis. Although interval increases in these markers had little value in detecting recurrent thrombotic events, D-dimer levels of 1000 ng/mL or greater and 500 ng/mL or greater had respective sensitivities of 89.3% and 100% in detecting early and late recurrences. Corresponding specificities were 35.6% and 53.9%. Conclusions: Initial D-dimer levels are determined by total thrombus load and remain elevated long after an acute DVT. F 1+2 levels are less sensitive to thrombus score and return to baseline more quickly. Initial levels of these markers may have some utility in predicting the risk of ultrasound scan–documented recurrences, whereas increased D-dimer levels are a sensitive but nonspecific marker of these events. (J Vasc Surg 2000;32:870-80.