ABSTRACT
Measurement of D-dimer (fibrin degradation product) is important for determining not
only the activation of fibrinolysis but also the severity of a hypercoagulable state.
However, fibrin degradation products are in variable, and the reactivity to cross-linked
fibrin degradation products produced during fibrin degradation differs depending on
the kind of antibody used against D-dimer. In patients with disseminated intravascular
coagulation or earthquake-induced mental and physical stress and in patients after
percutaneous transluminal coronary angioplasty, all of which are associated with acute
fibrin formation and degradation, some discrepancies between two methods of D-dimer
detection, automated latex agglutination assay (LPIA) and enzyme-linked immunosorbent
assay (Stago), were found. No discrepancies in persistent fibrin formation and degradation
were found among the healthy elderly, patients with lacunar stroke, and patients with
coronary artery disease, almost all of whom had levels under 5.0 μg/mL, as determined
by both methods. Evidence of persistently increased intravascular coagulation and
fibrin turnover in patients with atherosclerotic disease was found. The cleavage of
cross-linked fibrin by plasmin results in a production of fibrin degradation products,
mostly contained D-dimer domains. Although the clinical utility of D-dimer can be
achieved by their detection with specific antibodies, measurement of D-dimer as high-molecular-weight
fragments may be useful to determine whether patients will undergo further fibrin
degradation. When intermediate products of the degradation process need to be assessed,
D-dimer level measurement by LPIA may serve as a suitable marker for ongoing fibrinolysis.
KEYWORD
D-dimer - elderly - DIC - earthquake - lacunar stroke - coronary artery disease
