Download PDF
Thromb Haemost 1999; 81(02): 221-223
DOI: 10.1055/s-0037-1614446
Review Articles
Schattauer GmbH

Performances of the Fibrin Monomer Test for the Exclusion of Pulmonary Embolism in Symptomatic Outpatients

Guido Reber
2   From the Division of Angiology and Haemostasis and Medical Clinic 1, Geneva, Switzerland
,
Henri Bounameaux
2   From the Division of Angiology and Haemostasis and Medical Clinic 1, Geneva, Switzerland
,
Arnaud Perrier
1   the Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
,
Philippe de Moerloose
2   From the Division of Angiology and Haemostasis and Medical Clinic 1, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

Received03 July 1998

Accepted after resubmission29 October 1998

Publication Date:
08 December 2017 (online)

    Permissions and Reprints

Summary

Many studies have shown that D-dimer determinations can be used for the exclusion of venous thromboembolism in symptomatic outpatients, depending however on the method of D-dimer measurement. Another related assay, the Fibrin Monomer test which measures soluble fibrin levels in plasma by ELISA, is now available.

We have evaluated the performances of this assay for the exclusion of pulmonary embolism (PE) in 426 consecutive outpatients presenting at the emergency ward of our institution. Diagnosis of PE was made by D-dimer measurement, compression ultrasonography, lung scintigraphy, venography and pulmonary angiography. With a cut-off of 3 μg/ml, the sensitivity and the negative predictive value were both 100% (95% CI: 97.1-100 and 96.3-100 respectively) and the specificity 33% (95% CI: 25.7-38.1). With 4 μg/ml, the corresponding figures were 98.4 (95% CI: 94.4-99.8), 98.3 (95% CI: 94.1-99.8) and 39% (95% CI: 33.6-44.7) respectively. The prevalence of PE was 30%, the exclusion rates were 23 and 27% for either cut-off. When compared with a reference D-dimer assay (Asserachrom D-Di), a good correlation was observed. In conclusion, this is the first study suggesting the interest of this Fibrin Monomer test to rule out PE; these results, however, need to be confirmed by other studies.

 

  • References

  • 1 Perrier A, Desmarais S, Goehring C, de Moerloose P, Morabia A, Unger PF, Slosman D, Junod A, Bounameaux H. D-dimer testing for suspected pulmonary embolism in outpatients. Am J Respir Crit Care Med 1997; 156: 492-6.
    CrossrefPubMedGoogle Scholar
  • 2 van Beek EJ, Michel BC, van den Ende B, Brandjes DP, van der Heide YT, Bossuyt PM, Buller HR. The role of plasma D-dimer concentration in the exclusion of pulmonary embolism. Br J Haematol 1996; 92: 725-32.
    CrossrefPubMedGoogle Scholar
  • 3 Boneu B, Bes G, Pelzer H, Sié P, Boccalon H. D-dimers, thrombinantithrombin complexes and prothrombin fragments F1+2: diagnosis value in clinically suspected deep vein thrombosis. Thromb Haemost 1991; 65: 28-32.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Demers C, Ginsberg JS, Johnston M, Brill-Edwards P, Panju A. D-dimer and thrombin-antithrombin III complexes in patients with clinically suspected pulmonary embolism. Thromb Haemost 1992; 67: 408-12.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Bounameaux H, de Moerloose P, Perrier A, Miron M-J. D-dimer testing in suspected venous thromboembolism. Q J Med 1997; 90: 437-42.
    CrossrefPubMedGoogle Scholar
  • 6 Perrier A, Desmarais S, Miron MJ, de Moerloose P, Slosman D, Didier D, Unger PF, Patenaude JV, Bounameaux H. Noninvasive diagnosis of venous thromboembolism in outpatients including clinical probability, D-dimer and ultrasonography. Lancet, in press.
    PubMedGoogle Scholar
  • 7 Dempfle CE, Dollman M, Lill H, Puzzovio D, Dessauer A, Heene DL. Binding of a new monoclonal antibody against N-terminal heptapeptide of fibrin alpha-chain to fibrin polymerization site »A«: effects of fibrinogen and fibrinogen derivatives, and pretreatment of samples with NaSCN. Blood Coag Fibrinol 1993; 4: 79-86.
    CrossrefPubMedGoogle Scholar
  • 8 Lill H, Spannagl M, Trauner A, Schramm W, Schuller D, Ofenloch-Haehnle B, Draeger B, Naser W, Dessauer A. A new immunoassay for soluble fibrin enables a more sensitive detection of the activation state of blood coagulation in vivo. Blood Coag Fibrinol 1993; 4: 97-102.
    CrossrefPubMedGoogle Scholar
  • 9 Pfitzner SA, Demplfle CE, Matsuda M, Heene DL. Fibrin in plasma of patients with intravascular coagulation by fibrin-specific antibodies consists primarily of high molecular weight Factor XIIIa-crosslinked and plasmin-modified complexes partially containing fibrinopeptide A. Thromb Haemost 1997; 78: 1069-78.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Perrier A, Bounameaux H, Morabia A, Slosman D, Didier D, Unger PF, Junod A. Diagnosis of pulmonary embolism by a decision analysiS-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med 1996; 156: 531-6.
    CrossrefPubMedGoogle Scholar
  • 11 Vogel G, Demplfle CE, Spannagl M, Leskopf W. The value of quantitative fibrin monomer determination in the early diagnosis of postoperative deep vein thrombosis. Thromb Haemost 1996; 81: 241-51.
    PubMedGoogle Scholar
  • 12 Hanley JA, McNeil BJ. The meaning and use of the area under the receiver operator characteristic (ROC) curve. Radiology 1982; 143: 29-36.
    CrossrefPubMedGoogle Scholar
  • 13 Ginsberg JS, Siragusa S, Douketis J, Johnston M, Moffat K, Donovan D, McGinnis J, Brill-Edwards P, Panju A, Patel A, Weitz JI. Evaluation of a soluble fibrin assay in patients with suspected pulmonary embolism. Thromb Haemost 1996; 75: 551-4.
    Article in Thieme ConnectPubMedGoogle Scholar