Evaluation of plasma elastase, D-dimer and fibrin degradation products in comparison to doppler ultrasonography in the diagnosis of patients with deep vein thrombosis

ABSTRACT

The present work aimed at evaluating the usefulness of plasma elastase, D-dimer and fibrin [ogen] degradation products [FDPs] in comparison with doppler ultrasonography for the diagnosis of deep vein thrombosis [DVT] among 20 adult patients who were admitted to the emergency unit of Alexandria main University hospital with symptoms and signs suggestive of DVT. 10 healthy age and sex matched controls were also enrolled in this study. Plasma elastase, D-dimer were estimated by ELISA technique while FDPs by semiquantitative latex agglutination. They were done at presentation and 10 days after heparin therapy while they performed once in control group. It was found that the mean values of plasma D-dimer elastase and FDPs were significantly higher than those in control group both before [P[1]< 0.0001] and after therapy [P[2]< 0.0001] respectively. Post heparin therapy, the mean values of same parameters were significantly decreased when compared with pretreatment mean values using paired t-test [p= 0.000] for D dimer, elastase and FDPs respectively. As regards the extent of thrombus diagnosed by doppler ultrasonography, there was a significant increase in the mean values of D-dimer in proximal and all DVT than those in distal DVT while there was no significant difference between plasma elastase and FDPs and the extent of thrombus. A significant positive correlation was found between plasma D-dimer and elastase both before [r=0.845, p=/< 0.0001] and after heparin therapy [r= 0.764, p= 0.000]. No significant correlation was found between FDPs and the previous two parameters neither before nor after treatment. Doppler ultrasonography is a definitive test for diagnosis and localization of thrombus in DVT. Plasma D-dimer, elastase and FDPs can be used for initial evaluation of DVT suggestive patients in the emergency unit and further studies are needed to clarify their role in predicting the recurrence of DVT