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- Title
Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients.
- Authors
Roussi, J; Bentolila, S; Boudaoud, L; Casadevall, N; Vallee, C; Carlier, R; Lortat-Jacob, S; Dizien, O; Bussel, B
- Abstract
Deep vein thrombosis (DVT) is a common complication of paraplegia despite prophylactic anticoagulant therapy. The diagnosis relies primarily on ultrasonography or phlebography; these investigations are difficult, expensive and can be time-consuming in paraplegic patients. Study Design: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers, thrombin-antithrombin complexes, prothrombin fragments (F1+2) and activated factor VIIa. Objectives: To improve the diagnosis of deep venous thrombosis in paraplegic patients. Setting: This collaborative work was done at Raymond Poincaré Hospital, Garches, France. Methods: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers (D-Di), thrombin-antithrombin (TAT) complexes, prothrombin fragments (F1+2) and activated factor VIIa (FVIIa), were determined in a prospective study of 67 consecutive patients with paraplegia or tetraplegia. Doppler ultrasonography and/or phlebography of the lower limbs and D-Di, TAT, F1+2 level determination were systematically done in each patient at admission to our rehabilitation unit. Results: Despite prophylactic low molecular weight heparin therapy, six of the 67 patients developed DVT diagnosed by radiologic explorations. D-Di levels measured by a reference ELISA (Asserachrom D-Di, Diagnostica Stago) or a new rapid automated turbidimetric test (STA-Liatest D-Di) were greater than 500 ng/ml in all DVT patients and in 40 non-DVT patients, of whom most had urinary tract infections, osteomas, or pressure sores. D-Di values were normal in only 21/67 patients (31%). The negative predictive value of D-Di in our study was 100% since all DVT patients had D-Di values greater than 500 ng/ml. TAT and F1+2 levels were not correlated with D-Di levels but also had a negative predictive value of 100%. Comparison of D-Di levels obtained using the two tests showed that...
- Subjects
DIMERS; VENOUS thrombosis; SPINAL cord injuries; PARAPLEGIA
- Publication
Spinal Cord, 1999, Vol 37, Issue 8, p548
- ISSN
1362-4393
- Publication type
Article
- DOI
10.1038/sj.sc.3100891