Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands.
Scand J Clin Lab Invest. 2011 Feb;71(1):12-8. doi: 10.3109/00365513.2010.534173. Epub 2010 Nov 15.
The exclusion of deep venous thrombosis (DVT) by pre-test probability (PTP) and D-dimer in the elderly is safe, but has a low specificity. There is increasing interest in the diagnostic role of thrombin generation in patients with thrombosis. We evaluated the value of thrombin generation in the exclusion of DVT, especially in elderly patients.
All thrombin generation parameters of the Endogenous Thrombin Potential assay were tested retrospectively in a cohort of 443 patients suspected for DVT. The performance of the assay was calculated as AUC of the ROC curve and association with DVT as odds ratio (OR). The lag time value was combined with results of PTP and Innovance D-dimer assay.
All thrombin generation parameters had a low AUC. In the 4th age quartile, the corrected OR of lag time increased to 16 and the AUC of lag time for the combination PTP < 2 and D-dimers ≥ 500 μg/L was 0.96 with a cut-off value of 23.0 sec. The exclusion of DVT in patients ≥ 75 years (n = 30), based on this combination and lag time values ≤ 23.0 sec had a NPV of 100% and a specificity of 96.0% in this subgroup of patients and decreased the number needed to test from 10 to 1.1.
Thrombin generation parameters alone are inappropriate for the exclusion of DVT. However, in the elderly, the current algorithm of exclusion of DVT may improve markedly by the addition of the lag time results of the ETP.
通过预测试概率（PTP）和 D-二聚体排除老年患者深静脉血栓形成（DVT）是安全的，但特异性较低。目前，人们对血栓患者凝血酶生成的诊断作用越来越感兴趣。我们评估了凝血酶生成在排除 DVT 中的价值，特别是在老年患者中。
我们回顾性检测了 443 例疑似 DVT 患者的凝血酶生成的所有内源性凝血酶潜能检测参数。通过 ROC 曲线的 AUC 计算检测的性能，并将其与 DVT 的关联作为比值比（OR）。将滞后时间值与 PTP 和 Innovance D-二聚体检测的结果相结合。
所有凝血酶生成参数的 AUC 均较低。在第 4 个年龄四分位数中，滞后时间的校正 OR 增加到 16，PTP < 2 和 D-二聚体≥500 μg/L 组合的滞后时间 AUC 为 0.96，截断值为 23.0 秒。基于此组合和滞后时间值≤23.0 秒，排除年龄≥75 岁（n=30）患者的 DVT 的阴性预测值为 100%，特异性为 96.0%，在该患者亚组中，检测所需的人数从 10 人减少到 1.1 人。
单独使用凝血酶生成参数不适合排除 DVT。然而，在老年人中，通过添加 ETP 的滞后时间结果，目前排除 DVT 的算法可能会显著改善。
