CROSS-LINKED FIBRIN DEGRADATION PRODUCTS (XL-FDP) AS MARKER OF EARLY RETHROMBOSIS IN PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

The thrombotic response to percutaneous transluminal angioplasty (PTA) was investigated in 31 patients treated for 1-10cm femoropopliteal (n = 28) and tibial (n = 3) artery obstructions by measurement of cross-linked fibrin degradation products (XLFDP) in peripheral blood samples drawn before and 30 min after PTA. XL-FDP increased from 400 ± 147ng/ml to 700 ± 445 ng/ml (median ± s.e., p = 0.0005). XL-FDP rose from 320 ± 110 ng/ml to 540 ± 102 ng/ml in 23 patients, whose anklel brachial systolic blood pressure index (ABI) increased > 0.15 after PTA, whereas XL-FDP increased from 850 ± 450 ng/ml to 2620 ± 1472 ng/ml in eight patients, who failed to increase ABI in spite of preceding recanalisation. XL-FDP increased by more than 1000 ng/ml in 1/23 (4.3%) patients with uncomplicated PTA and in 6/8 (75%) patients with haemodynamic failure (p = 0.0005). Using a XL-FDP increase of 1000 ng/ml as cut-off, estimates of positive and negative predictive values (95% confidence limits) for early failure of PTA were 85.7% (42.1-99.6%) and 91.7% (73.0-99.0%), respectively. We conclude from this pilot study that femorotibial PTA produces a hypercoagulable state which may result in failure of early patency due to rethrombosis. We suggest for the first time XL-FDP as a marker of early rethrombosis in PTA, and report a sequential XL-FDP assay which may be useful for identification of high-risk patients requiring thrombolytic therapy after PTA for maintenance of early vascular patency. © 1993 Grune & Stratton Ltd.