The Usefulness of the Combination of D-Dimer and Soluble Fibrin Monomer Complex for Diagnosis of Venous Thromboembolism in Psychiatric Practice: A Prospective Study

Abstract

Purpose

D-dimer has the advantage of excluding venous thromboembolism (VTE) due to its high sensitivity but is disadvantageous for diagnosing VTE due to its low specificity. A method to increase the usefulness of D-dimer in the diagnosis of VTE is warranted. This study aimed to investigate the usefulness of the combination of D-dimer and soluble fibrin monomer complex (SFMC), which has been suggested as a new candidate marker for VTE, in VTE diagnosis.

Patients and Methods

This prospective study in 109 subjects was performed at a psychiatric department between August 1, 2017 and December 31, 2019. Subjects’ levels of D-dimer and SFMC were measured simultaneously. Plasma levels of D-dimer and SFMC were measured using NANOPIA^® D-dimer and NANOPIA^® SF. Subjects with positive D-dimer (≥1.0 µg/mL) results underwent contrast computed tomography for confirmation of VTE within 12 hours of D-dimer measurement. A receiver operating characteristic curve analysis was performed to examine the usefulness of SFMC for the diagnosis of VTE.

Results

Only 109 of the 783 subjects without symptoms suggestive of VTE participated in the study. Out of 41 subjects with positive D-dimer results, 17 subjects were diagnosed with VTE. A receiver operating characteristic curve analysis was performed to determine cutoff values. The area under the curves was 0.848 for SFMC (p<0.001, 95% CI 0.722 to 0.974), and the optimal cutoff value was 10.0 µg/mL (sensitivity 58.8%, specificity 100%, positive predictive value 100%, negative predictive value 77.4%).

Conclusion

SFMC was useful for diagnosing VTE in the psychiatric patients with positive D-dimer results.

Keywords:

• computed tomography
• D-dimer
• psychiatric patients
• soluble fibrin monomer complex
• venous thromboembolism

Abbreviations

AUC, area under the curve; BMI, body mass index; CI, confidence interval; CT, computerized tomography; DIC, disseminated intravascular coagulation; DVT, deep vein thrombosis; PE, pulmonary embolism; ROC, receiver operating characteristic; SFMC, soluble fibrin monomer complex; VTE, venous thromboembolism.

Data Sharing Statement

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

Author Contributions

All authors made substantial contributions to the conception and design of the study and to the acquisition of data or the analysis and interpretation of data; they all took part in drafting the article or revising it critically for important intellectual content; they gave their final approval of the version to be published; and all authors agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.