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. 1990 Sep;45(9):684–687. doi: 10.1136/thx.45.9.684

Plasma cross linked fibrin degradation products in pulmonary embolism.

B J Rowbotham 1, J Egerton-Vernon 1, A N Whitaker 1, M J Elms 1, I H Bunce 1
PMCID: PMC462695  PMID: 2218975

Abstract

Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. There was a difference between the mean levels of cross linked fibrin degradation products in each scan category: normal scans, 142 ng/ml; low probability scans, 295 ng/ml; indeterminate probability scans, 510 ng/ml; high probability scans, 952 ng/ml (p less than 0.001). Of the patients with high probability scans, 96% had raised concentrations. Explanations for discrepant low results include incorrect scan diagnosis, delay in blood sampling, and anticoagulation. Of the patients with a low or indeterminate probability of pulmonary embolism, 43% had increased concentrations of cross linked fibrin degradation products that could be attributed in most cases to another illness. Owing to the wide range of values in each lung scan diagnostic category, raised concentrations of these fibrin degradation products cannot be used without reference to the patient's clinical state as a discriminatory test for pulmonary embolism. Further evaluation of the significance of normal concentrations in excluding a diagnosis of pulmonary embolism appears to be warranted.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderson P. O., Biello D. R., Sachariah K. G., Siegel B. A. Scintigraphic detection of pulmonary embolism in patients with obstructive pulmonary disease. Radiology. 1981 Mar;138(3):661–666. doi: 10.1148/radiology.138.3.7465843. [DOI] [PubMed] [Google Scholar]
  2. Biello D. R., Mattar A. G., McKnight R. C., Siegel B. A. Ventilation-perfusion studies in suspected pulmonary embolism. AJR Am J Roentgenol. 1979 Dec;133(6):1033–1037. doi: 10.2214/ajr.133.6.1033. [DOI] [PubMed] [Google Scholar]
  3. Bounameaux H., Slosman D., de Moerloose P., Reber G. Diagnostic value of plasma D-dimer in suspected pulmonary embolism. Lancet. 1988 Sep 10;2(8611):628–629. doi: 10.1016/s0140-6736(88)90665-4. [DOI] [PubMed] [Google Scholar]
  4. Bynum L. J., Crotty C. M., Wilson J. E., 3rd Diagnostic value of tests of fibrin metabolism in patients predisposed to pulmonary embolism. Arch Intern Med. 1979 Mar;139(3):283–285. [PubMed] [Google Scholar]
  5. Cade J., Hirsh J., Regoeczi E. Mechanisms for elevated fibrin/fibrinogen degradation products in acute experimental pulmonary embolism. Blood. 1975 Apr;45(4):563–568. [PubMed] [Google Scholar]
  6. Davis R. B., Schauwecker D. S., Siddiqui A. R., Becker G. J., Holden R. W., Richmond B. D., Wellman H. N. Indeterminate lung imaging. Can the number be reduced? Clin Nucl Med. 1986 Aug;11(8):577–582. doi: 10.1097/00003072-198608000-00014. [DOI] [PubMed] [Google Scholar]
  7. Elms M. J., Bunce I. H., Bundesen P. G., Rylatt D. B., Webber A. J., Masci P. P., Whitaker A. N. Rapid detection of cross-linked fibrin degradation products in plasma using monoclonal antibody-coated latex particles. Am J Clin Pathol. 1986 Mar;85(3):360–364. doi: 10.1093/ajcp/85.3.360. [DOI] [PubMed] [Google Scholar]
  8. Farrell R. J., Duffy M. J., Duffy G. J. Serum fragment E and plasma beta-thromboglobulin in patients with acute pulmonary embolism and non-thromboembolic lung diseases. Thromb Res. 1982 Jul 15;27(2):231–234. doi: 10.1016/0049-3848(82)90204-3. [DOI] [PubMed] [Google Scholar]
  9. Gaffney P. J., Perry M. J. Unreliability of current serum fibrin degradation product (FDP) assays. Thromb Haemost. 1985 Jun 24;53(3):301–302. [PubMed] [Google Scholar]
  10. Goldhaber S. Z., Vaughan D. E., Tumeh S. S., Loscalzo J. Utility of cross-linked fibrin degradation products in the diagnosis of pulmonary embolism. Am Heart J. 1988 Aug;116(2 Pt 1):505–508. doi: 10.1016/0002-8703(88)90625-4. [DOI] [PubMed] [Google Scholar]
  11. Hull R. D., Hirsh J., Carter C. J., Jay R. M., Dodd P. E., Ockelford P. A., Coates G., Gill G. J., Turpie A. G., Doyle D. J. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med. 1983 Jun;98(6):891–899. doi: 10.7326/0003-4819-98-6-891. [DOI] [PubMed] [Google Scholar]
  12. Hull R. D., Hirsh J., Carter C. J., Raskob G. E., Gill G. J., Jay R. M., Leclerc J. R., David M., Coates G. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest. 1985 Dec;88(6):819–828. doi: 10.1378/chest.88.6.819. [DOI] [PubMed] [Google Scholar]
  13. McKay D. G., Franciosi R., Zeller J. Symposium on thrombohemorrhagic phenomena. II. Am J Cardiol. 1967 Sep;20(3):374–380. doi: 10.1016/0002-9149(67)90061-6. [DOI] [PubMed] [Google Scholar]
  14. Rickman F. D., Handin R., Howe J. P., Alpert J. S., Dexter L., Dalen J. E. Fibrin split products in acute pulmonary embolism. Ann Intern Med. 1973 Nov;79(5):664–668. doi: 10.7326/0003-4819-79-5-664. [DOI] [PubMed] [Google Scholar]
  15. Rowbotham B. J., Carroll P., Whitaker A. N., Bunce I. H., Cobcroft R. G., Elms M. J., Masci P. P., Bundesen P. G., Rylatt D. B., Webber A. J. Measurement of crosslinked fibrin derivatives--use in the diagnosis of venous thrombosis. Thromb Haemost. 1987 Feb 3;57(1):59–61. [PubMed] [Google Scholar]
  16. Ruckley C. V., Das P. C., Leitch A. G., Donaldson A. A., Copland W. A., Redpath A. T., Scott P., Cash J. D. Serum fibrin-fibrinogen degradation products associated with postoperative pulmonary embolus and venous thrombosis. Br Med J. 1970 Nov 14;4(5732):395–398. doi: 10.1136/bmj.4.5732.395. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Smart R. C., Lyons N. R., Burke J. J., Wood C. F. A combined procedure for 99mTc aerosol ventilation and perfusion imaging. Eur J Nucl Med. 1985;11(2-3):65–68. doi: 10.1007/BF00252135. [DOI] [PubMed] [Google Scholar]
  18. Whitaker A. N., Elms M. J., Masci P. P., Bundesen P. G., Rylatt D. B., Webber A. J., Bunce I. H. Measurement of cross linked fibrin derivatives in plasma: an immunoassay using monoclonal antibodies. J Clin Pathol. 1984 Aug;37(8):882–887. doi: 10.1136/jcp.37.8.882. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Yudelman I. M., Nossel H. L., Kaplan K. L., Hirsh J. Plasma fibrinopeptide A levels in symptomatic venous thromboembolism. Blood. 1978 Jun;51(6):1189–1195. [PubMed] [Google Scholar]
  20. van Hulsteijn H., Briët E., Koch C., Hermans J., Bertina R. Diagnostic value of fibrinopeptide A and beta-thromboglobulin in acute deep venous thrombosis and pulmonary embolism. Acta Med Scand. 1982;211(5):323–330. doi: 10.1111/j.0954-6820.1982.tb01956.x. [DOI] [PubMed] [Google Scholar]

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