Fibrinolysis

D-dimer Elevated 6 Months

Dear George, I am a 42 year old African American women in fairly good health. I am obese and I live a partly active life. I went to the emergency room back in January of this year for chest pain and palpitations. While there they did a D-dimer test and a chest CT scan. I […]

Therapeutic Reptilase

Ning Tang writes, Dear George, In China, a categary of hemostatic agents from snake venom named “Haemocoagulase” are widely used, basically they are the generic drugs of Reptilase®, which is produced by a Swiss company. We find that intravenous injection of this drug can cause severe hyperfibrinolysis and hypofibrinogenemia. It seems that Reptilase has been […]

Bleeding Disorders

Case Study: A Patient on Xarelto with Elevated D-dimer Results

In 2016, Dr. Louann Lawrence, New Orleans, communicated with a patient who had experienced a DVT and PE in 2014 and was being treated with Xarelto (rivaroxaban). The patient’s physician routinely ordered a D-dimer to assess the risk of a recurrence after discontinuing anticoagulant therapy. Following the physician’s instructions, the patient discontinues Xarelto for 24 […]

Anticoagulant Therapy

D-dimer Reference Range

Paul Smith writes, “I have a family member on Xarelto and his D-dimer reference range was 450 while taking Xarelto. What is the reference range? Hello, Mr. Smith, and thank you for your question. There is some mild confusion about the D-dimer reference intervals (reference ranges) because several distributors use varient methods. These methods result […]

Anticoagulant Therapy

March, 2018 Quick Question: D-dimer Controls

Here are the results of our March, 2018 Quick Question about the appropriate D-dimer controls. What controls are most valid for managing D-dimer assay precision? VTE decision point control only; 500 ng/mL FEUs 10% (3) Low end of linearity & VTE decision point: 100 and 500 ng/mL FEUs: 32% (10) Low and high ends of […]

Inflammatory Biomarkers

Wherever you turn you see reference to the effects of chronic inflammation related to heart disease, stroke, diabetes, and chronic kidney disease. Here is a link to a March, 2018 CAP Today article by Anne Paxton about the relationship of inflammatory biomarkers to chronic kidney disease in diabetes. George is especially interested in the tie-in […]

TXA in DIC

A colleague asks what people are doing in regards to the antifibrinolytic TXA use in patients with DIC who are massively hemorrhaging. George has found a number of articles describing the efficacy of tranexamic acid and epsilon-amino-caproic acid in treating post-partum hemorrhage, which is close, but nothing directly recording TXA in DIC. If you have […]

Dr. John Olson on D-dimer Vs FDP

Hello George, Good to hear from you. I hope that all is well with you. Greet the folks at Precision the next time you see them. There are a number of questions that would be good to raise. For example, for what clinical situations are the OB docs using FSP? It cannot, of course, be used […]

D-dimer versus FDP

From Anne Gaffney: Hi George, we would like to discontinue our fibrin degradation products (FDP, fibrin split products, FSP) latex agglutination testing, however the OB docs like to use the less sensitive test as the D-dimer test is “always” positive in their pregnant patients. Do you have any evidence based literature to help us support […]

August Quick Question: Fibrinolysis

Here are the results of our August, 2017 Quick Question with 68 total votes: How do you test for fibrinolysis? a. TEG or TEM: 9 (13%) b. D-dimer: 36 (53%) c. Plasminogen: 0 (0%) d. PAI-1: 1 (1%) e. D-dimer plus plasminogen: 10 (15%) f. D-dimer, plasminogen, and PAI-1: 6 (9%) f. We don’t test […]

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George Fritsma is a medical laboratory scientist, educator, and author. George is a member of the International Society on Thrombosis and Hemostasis, the International Society for Laboratory Hematology, and the American Society for Clinical Laboratory Science.

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