Key result
Endogenous thrombin potential and overall hemostatic potential fail to beat D-dimer for VTE discrimination.
Why the study?
A biomarker with higher specificity than D-dimer for acute venous thromboembolism would be of great clinical use, but thrombin generation and overall hemostatic potential have yet to be established as clinical biomarkers of VTE.
Do endogenous thrombin potential, overall hemostatic potential, and fibrin monomers improve diagnostic accuracy for acute venous thromboembolism compared to D-dimer in outpatients with suspected VTE?
Cross-Sectional (n=158)
No
Do endogenous thrombin potential, overall hemostatic potential, and fibrin monomers improve diagnostic accuracy for acute venous thromboembolism compared to D-dimer in outpatients with suspected VTE?
Effect estimate: AUC 0.65 for ETP, 0.94 for D-dimer
D-dimer remains the superior biomarker for diagnosing acute venous thromboembolism compared to global hemostatic assays like ETP and OHP.
D-dimer remains preferred for suspected VTE diagnosis; confirms its superiority and leaves open the search for better biomarkers.
Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE. Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE. Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records. Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay. Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.
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Farm et al. (2020) conducted a cross-sectional in Suspected acute venous thromboembolism (n=158). Endogenous thrombin potential (ETP) and overall hemostatic potential (OHP) vs. D-dimer and fibrin monomers (FM) was evaluated on Discrimination between VTE and non-VTE (AUC 0.65 for ETP, 0.94 for D-dimer). Endogenous thrombin potential (AUC 0.65) and overall hemostatic potential were not clinically viable biomarkers for acute venous thrombosis compared with D-dimer (AUC 0.94).
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