D-DIMER DURING INTRAARTERIAL LOW-DOSE STREPTOKINASE TREATMENT OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

In order to assess systemic and local intra-arterial levels of D-dimer , a specific degradation product of cross-linked fibrin, blood samples were obtained before and 0.5, 1.5, 4, 8, 24, and 48 hours after the s tart of intra-arterial low dose streptokinase treatment (3750 IU/h) in 21 patients with angiographically documented peripheral arterial occl usive disease. Blood was sampled simultaneously from the cuhital vein and from the arterial catheter located close to the occlusive thromhus . Pre-treatment D-dimer levels in arterial and venous blood were 298 a nd 259 ng/mL (medians), respectively. During the first day of treatmen t D-dimer levels in arterial blood increased on average 10-20 fold and were at all times significantly higher than D-dimer levels in venous blood (artery vs vein; 0.5 h: 414 vs 266; 1.5 h: 2640 vs 411; 4 h: 239 0 vs 898; 8 h: 2640 vs 906; 24 h: 6290 vs 1060 ng/mL, medians). In 13 patients in whom recanalization was achieved D-dimer levels were highe r than in 8 unsuccessfully treated patients (vein: p < 0.05; artery: n ot significant). Significant decreases in plasminogen, alpha(2)- antip lasmin, fibrinogen and euglobulin clot lysis time indicated fibrinolyt ic activation in local arterial as well as in systemic venous blood. I t was concluded that higher D-dimer in the vicinity of the thrombus co mpared to systemic levels reflected local lysis of fibrin. Systemic le vels of D-dimer might provide early information on the efficacy of the treatment.