FIBRINOGEN FIBRIN DEGRADATION PRODUCTS AND D-DIMER IN CLINICAL-PRACTICE - INTERPRETATION OF DISCREPANT RESULTS

In clinical practice, occasionally some patients show dissociated values of fibrinogen/fibrin degradation products (FDP) and D-dimer (cross-linked fibrin degradation products). In an attempt to assess the frequency, clinical backgrounds, and hemostatic states of these cases, FDP and D-dimer were simultaneously measured together with other hemostatic parameters in 371 samples from patients with various diseases. As a whole, FDP values were positively correlated with D-dimer values (r = 0.871, P < 0.0001), and both were elevated in parallel with the progress of activation of blood coagulation and fibrinolysis. However, in patients with elevated FDP and/or D-dimer, 11.5% of samples showed relatively lower D-dimer values than those expected from FDP levels, and these were regarded as an apparently dissociated group. In the dissociated group, activation of coagulation and fibrinolysis occurred to a lesser extent than others, Analysis of these samples suggested that the possible reasons for the dissociation between FDP and D-dimer values were accelerated fibrinogenolysis with or without secondary fibrinolysis, accelerated fibrinogenolysis by non-plasmic proteinases, elevated soluble fibrin, and possibly false-positive FDP levels due to unclottable fibrinogen remaining in the serum samples. In practice, simultaneous measurements of FDP and D-dimer are useful for more accurate estimation of hyperfibrinolytic states. (C) 1995 Wiley-Liss, Inc.