J. Roussi et al., Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients, SPINAL CORD, 37(8), 1999, pp. 548-552
Deep vein thrombosis (DVT) is a common complication of paraplegia despite p
rophylactic anticoagulant therapy. The diagnosis relies primarily on ultras
onography or phlebography; these investigations are difficult, expensive an
d 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 paraplegi
c patients.
Setting: This collaborative work was done at Raymond Poincare Hospital, Gar
ches, France.
Methods: To evaluate the usefulness of coagulation activation markers in ex
cluding a diagnosis of DVT, D-Dimers (D-Di), thrombin-antithrombin (TAT) co
mplexes, prothrombin fragments (F1+2) and activated factor VIIa (FVIIa), we
re determined in a prospective study of 67 consecutive patients with parapl
egia or tetraplegia. Doppler ultrasonography and/or phlebography of the low
er limbs and D-Di, TAT, F1+2 level determination were systematically done i
n 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 le
vels measured by a reference ELISA (Asserachrom D-Di, Diagnostica Stage) or
a new rapid automated turbidimetric test (STA-Liatest D-Di) were greater t
han 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. TBT and F1+2 levels were not correlated with D-Di levels but als
o had a negative predictive value of 100%. Comparison of D-Di levels obtain
ed using the two tests showed that results of the reference ELISA were clos
ely correlated to those of the new rapid automated turbidimetric. TAT, F1+2
, and factor VIIa are not useful for measuring hypercoagulability in parapl
egic or tetraplegic patients since no rapid tests for determining these par
ameters are available.
Conclusion: D-Di levels determined using an ELISA or a new rapid automated
turbidimetric test have a good negative predictive value for DVT in paraple
gic or tetraplegic patients and may reduce the need for Doppler ultrasonogr
aphy and/or phlebography by 31%.