Fibrinolytic response to venous occlusion for 10 and 20 minutes in healthy subjects and in patients with deep vein thrombosis

1989 ◽  
Vol 56 (2) ◽  
pp. 251-263 ◽  
Author(s):  
J. Petäjä
Keyword(s):  
Deep Vein Thrombosis ◽  
Healthy Subjects ◽  
Venous Occlusion ◽  
Vein Thrombosis ◽  
Deep Vein

Evaluation of Acute Deep Venous Thrombosis of the Lower Limb, Using an Automated Venous Occlusion Plethysmograph

1991 ◽  
Vol 6 (4) ◽  
pp. 241-248 ◽  
Author(s):  
Håkan Ahlström ◽  
Stefan Nilsson ◽  
Göran Hellers
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Strain Gauge ◽  
Lower Limb ◽  
False Negative ◽  
Venous Occlusion ◽  
Vein Thrombosis ◽  
Deep Vein

One-hundred-and-eleven consecutive patients who were referred for routine phlebography because of clinically suspected deep vein thrombosis (DVT) were also investigated with a new, simplified, computerized strain-gauge plethysmograph (Phlebotest, Eureka AB). An occlusion plethysmograph curve was obtained from each leg simultaneously. Four different numerical parameters were defined and determined from this curve. These parameters were correlated with the phlebographic diagnosis. Three of the parameters of the plethysmograph curve correlated well with the phlebographic diagnosis, which proved correct in 54 patients without DVT, including two false negative cases, and in 12 patients with thrombosis. In 45 patients, plethysmography alone was not sufficient to establish a diagnosis. The plethysmograph described is easy to handle and is suggested for use in selecting those patients, with or without thrombosis, who do not require supplementary phlebography.

Hypofibrinolysis in Patients with a History of Idiopathic Deep Vein Thrombosis and/or Pulmonary Embolism

1992 ◽  
Vol 67 (04) ◽  
pp. 397-401 ◽  
Author(s):  
Vito Grimaudo ◽  
Fedor Bachmann ◽  
Jacques Hauert ◽  
Maria-Adele Christe ◽  
Egbert K O Kruithof
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Plasminogen Activator ◽  
Fibrinolytic Activity ◽  
Venous Occlusion ◽  
Vein Thrombosis ◽  
Molar Excess ◽  
History Of ◽  
Deep Vein ◽  
Pai 1

SummaryAn impaired fibrinolytic activity after a venous occlusion test is the most common abnormality associated with thomboembolic disease. To better characterize the causes of abnormal responses we have measured different fibrinolytic parameters, before and after 10 and 20 min of venous occlusion, in 77 patients with a history of idiopathic deep vein thrombosis and/or pulmonary embolism and in 38 healthy volunteers.The patients had a lower mean fibrinolytic response to venous occlusion than the controls and higher antigen levels of tissue-type plasminogen activator (t-PA: Ag) and plasminogen activator inhibitor type 1 (PAI-1:Ag). Before venous occlusion, PAI-1 levels were at a molar excess over those of t-PA in all patients and controls. After 20 min of venous occlusion, the release of t-PA from the vascular endothelium resulted in a molar excess of t-PA over PAI-1 in the majority of controls (72%) but only in a minority of patients (39%).To identify patients with fibrinolytic abnormalities, reference intervals (RI) for fibrinolytic activity, t-PA:Ag and PAI-1:Ag were established in healthy controls. None of the patients had low levels of t-PA:Ag, but 17 (22%) had elevated PAI-1:Ag levels before venous occlusion and 12 (16%) exhibited low fibrinolytic activity after 20 min of venous occlusion. Ten of these were among the 17 subjects with high PAI-1: Ag levels before venous occlusion. Thus, the measurement of PAI-1:Ag levels before venous occlusion (i.e. in samples taken without any stimulation) is a sensitive (83%) and specific (89%) assay for the detection of patients with an impaired fibrinolytic response to venous occlusion.

A Practical Screener for Deep Vein Thrombosis after Total Hip Replacement

1996 ◽  
Vol 6 (4) ◽  
pp. 140-148 ◽  
Author(s):  
M.A. McNally ◽  
M.D. Crone ◽  
R.A.B. Mollan
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Strain Gauge ◽  
Hip Replacement ◽  
Venous Occlusion ◽  
Initial Assessment ◽  
Consecutive Series ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Deep Vein

A new non-invasive screener for the detection of proximal deep vein thrombosis was evaluated in two consecutive series of patients undergoing primary total hip replacement. The system, which utilises computerised strain gauge venous occlusion plethysmography, was simple to use and allowed serial screening of large numbers of patients without complication. Comparison with venography in 112 patients gave a specificity of 96% (106/110) and a sensitivity of 100% (2/2) for clinically important proximal DVT. Based on this study, a larger management study was performed. After total hip replacement, 516 patients were serially screened and all were followed to at least four months (mean 7.6 months) from surgery. Venography was only requested after a positive screening test. The screener correctly identified proximal and major calf thrombi in this group allowing early treatment. There were no fatal pulmonary emboli. This initial assessment suggests that computerised strain gauge plethysmography may be useful in identifying those patients with silent venous thrombosis after total replacement.

The incidence of activated protein C resistance among patients with deep vein thrombosis and healthy subjects in Osaka

1995 ◽  
Vol 79 (2) ◽  
pp. 227-229 ◽  
Author(s):  
J. Kambayashi ◽  
H. Fujimura ◽  
T. Kawasaki ◽  
M. Sakon ◽  
M. Monden ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Healthy Subjects ◽  
Protein C ◽  
Activated Protein C ◽  
Activated Protein C Resistance ◽  
Vein Thrombosis ◽  
Deep Vein

Fibrinolytic Response and Fibrin Fragment D-Dimer Levels in Patients with Deep Vein Thrombosis

1987 ◽  
Vol 58 (04) ◽  
pp. 1024-1029 ◽  
Author(s):  
P J Declerck ◽  
P Mombaerts ◽  
P Holvoet ◽  
M De Mol ◽  
D Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Occlusion ◽  
Antigenic Determinants ◽  
Enzyme Linked Immunosorbent Assay ◽  
Vein Thrombosis ◽  
Pathological Conditions ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

SummaryAn enzyme-linked immunosorbent assay for fragment D-dimer was developed with the use of two monoclonal antibodies directed against specific non-overlapping antigenic determinants, present in fragment D-dimer of crosslinked fibrin but not in fragment D of non crosslinked fibrin or of fibrinogen, The lower limit of sensitivity of the assay when applied to human plasma, is 25 ng/ml. Concentration of fragment D-dimer in plasma from healthy individuals was 177 ,± 83 ng/ml (mean ± SD). In plasma of 11 out of 12 patients with phlebographically confirmed acute deep vein thrombosis, fragment D-dimer levels were significantly increased. Fragment D-dimer was not increased in 9 out of 10 patients with recurrent idiopathic deep vein thrombosis during clinically silent episodes.Total t-PA antigen and free t-PA antigen concentrations were measured using previously developed ELISAs. Nine of the 12 patients with acute deep vein thrombosis showed a significant increase of total t-PA antigen (from 8.6 ± 6.9 ng/ml to 21 ± 16 ng/ml) after venous occlusion but in 3 of these free t-PA remained undetectable. Five of the 10 patients with recurrent deep vein thrombosis responded to venous occlusion with a significant increase of total t-PA antigen (from 6.7±3.2 ng/ml to 14 ± 7.9 ng/ml) but, in all patients, free t-PA antigen remained undetectable.It is concluded that the combined assays of total and free t-PA antigen and of fragment D-dimer may be useful for the evaluation of the dynamics of the fibrinolytic system in physiological and pathological conditions.

Poor fibrinolytic response to venous occlusion by different criteria in patients with deep vein thrombosis

1991 ◽  
Vol 64 (4) ◽  
pp. 445-453 ◽  
Author(s):  
Mojca Stegnar ◽  
Polona Peternel ◽  
Dušan Keber ◽  
Nina Vene
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Occlusion ◽  
Vein Thrombosis ◽  
Deep Vein

4G/5G Polymorphism of PAI-1 Gene Promoter and Fibrinolytic Capacity in Patients with Deep Vein Thrombosis

1998 ◽  
Vol 80 (12) ◽  
pp. 956-960 ◽  
Author(s):  
Maria Teresa Sartori ◽  
Björn Wiman ◽  
Silvia Vettore ◽  
Francesco Dazzi ◽  
Antonio Girolami ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Healthy Subjects ◽  
Gene Promoter ◽  
Insertion Polymorphism ◽  
Vein Thrombosis ◽  
Lysis Time ◽  
Euglobulin Lysis Time ◽  
Deep Vein ◽  
Fibrinolytic Capacity ◽  
Pai 1

SummaryA deletion/insertion polymorphism (4G or 5G) in the promoter of the plasminogen activator inhibitor type 1 gene has been suggested to be involved in regulation of the synthesis of the inhibitor, the 4G allele being associated with enhanced gene expression. A relationship between 4G/5G polymorphism and PAI-1 levels was found in patients with cardiovascular and metabolic diseases, but not in healthy subjects. In the present work we studied the distribution of PAI-1 4G/5G geno-type and its relation to fibrinolytic capacity in 70 unrelated patients with deep vein thrombosis. Each patient was assayed before and after 20 min. Venous occlusion for euglobulin lysis time, t-PA antigen and activity, and PAI-1 antigen and activity. The prevalence of 5G homozygous carriers was significantly lower in patients than in controls (10% vs. 26%, p = 0.009). The 5G allele frequency was reduced, even though not significantly, in DVT patients compared to healthy subjects (0.40 vs. 0.51, respectively). In the patient group, the mean PAI-1 antigen and activity levels were significantly higher than among controls and related to the 4G/5G polymorphism. In patients with 4G/5G and 4G/4G genotype a significant correlation was found between PAI-1 levels and the global fibrinolytic activity as evaluated by euglobulin lysis time. The prevalence of a reduced fibrinolytic potential due to PAI-1 excess was 45.7% among DVT patients. Moreover, the prevalence of PAI-1 induced hypofibrinolysis was strongly related to PAI-1 polymorphism, since it was significantly lower in 5G homo-zygous patients (28.6%) than in both 4G/5G carriers (55.3%, p <0.001) and 4G homozygous patients (57.9%, p <0.001).In conclusion, in patients with deep vein thrombosis the 4G polymorphism of PAI-1 gene promoter may influence the expression of PAI-1 and it should be taken into consideration as a facilitating condition for pathological fibrinolysis together with other environmental and genetic factors. Whether this has any significance in regard to the pathogenesis of venous thrombosis remains to be proven.

PLASMINOGEN ACTIVATOR INHIBITOR ACTIVITY AND ANTIGEN (PAI 1), RELATIONSHIP TO FIBRINOLYTIC RESPONSE AFTER VENOUS OCCLUSION IN 48 PATIENTS WITH DEEP VEIN THROMBOSIS

1987 ◽  
Author(s):  
G Nguyen ◽  
M H Horellou ◽  
J Conard ◽  
P Van Dreden ◽  
E K O Kruithof ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Plasminogen Activator ◽  
Venous Occlusion ◽  
Venous Stasis ◽  
Activity Levels ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Pai 1 ◽  
Group 1

Fibrinolytic parameters were studied before and after a 10 minute venous occlusion (VO) in 48 patients with confirmed deep vein thrombosis (DVT), at least 3 months after the last thrombotic episode. Congenital antithrombin III or protein C deficiencies were ruled out in these patients. The following tests were performed : euglobulin clot lysis time (ECLT), diluted whole blood lysis times (DWBLT), tissue plasminogen activator (t-PA) antigen (Biopool kit) and activity (fibrin plates), PAI activity (Verheijen et al.) and PAI i antigen (RIA, Kruithof et al.).Patients were divided in 2 groups : group 1 (27 patients) with normal fibrinolytic response (ECLT and DWBLT less than 90 min. after VO), group 2 (21 patients) with defective fibrinolytic response at least twice with a few weeks time interval. In group 1, the mean t-PA antigen release after VO was 32.0 ± 27.2 ng/ml (post-occlusion value minus preocclusion value) and was associated with low or normal levels of basal PAI activity (7.1 ±3.1 IU/ml), and PAI 1 antigen (15.1 ±4.1 ng/ml, n = 7). These results could explain the good response to VO, and a PAI activity suppression after stasis (PAI activity undetectable in 20 out of 27 patients).In contrast, in group 2, a low t-PA Ag increase after VO:10.5 ± 8.2 ng/ml as compared to group 1 (p <0.001) was associated with high levels of basal PAI activity : 22.4 ± 15.4 IU/ml (p <0.001), and PAI 1 Ag : 43.6 ± 24.9 ng/ml (n = 11, p <0.001). This association may account for the impaired fibrinolytic response aftep V0, and for persistant high PAI activity levels after stasis (17.6 ± 22.5 IU/ml). Before V0, PAI 1 Ag levels were in good correlation with PAI activity (r = 0.66, p <0.01), and , were significantly higher in group 2 as compared to group 1 (only 3 patients belonging to group 2 had normal PAI levels).Since elevated PAI 1 antigen and PAI activity levels were associated with an abnormal fibrinolytic response to venous stasis, VO test could be restricted to patients with normal PAI levels, in order to detect hypofibrinolysis related to insufficient t-PA release.

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