Shining a Light on Deep Vein Thrombosis: An Interview with Dr Jana Koporcová, Unilabs Slovakia Medical Manager

Deep vein thrombosis (DVT) is a serious condition characterised by the formation of blood clots in the deep veins, typically in the legs. Accurate diagnosis and effective management are crucial to prevent complications, such as pulmonary embolism. At Unilabs, we use advanced diagnostic procedures to aid healthcare professionals in diagnosing and managing DVT. We spoke with Dr Jana Koporcová, to gain insights into the diagnostic and therapeutic approaches available for DVT patients.

What is the primary laboratory test used for diagnosing DVT?

The most widely used blood test for diagnosing DVT is the determination of D-dimer concentration. D-dimer is a fibrin degradation product, and its levels can be measured using monoclonal antibodies against D-dimer molecules. Under normal physiological conditions, D-dimer concentrations in peripheral blood are low. However, elevated levels can be observed in conditions associated with increased fibrin formation and degradation, such as DVT.

Is the presence of elevated D-dimer levels specific to DVT?

No. D-dimer levels can also be increased in patients with oncological diseases, pregnant women, individuals who have recently undergone surgery, and elderly patients. Therefore, while elevated D-dimer levels can indicate the presence of a thrombotic event, they are not definitive for DVT, therefore further investigations are required for a DVT diagnosis.

What other markers are important in diagnosing and treating DVT?

In patients with acute DVT, a hypercoagulable state (the tendency for blood to form clots) and activation of inflammation can be indicated by elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocytes, and fibrinogen. Additionally, levels of antithrombin III (AT III)—a protein in the blood that acts as a natural anticoagulant—are typically decreased in extensive thrombosis, due to consumption. Monitoring AT III is crucial for assessing the efficacy of DVT treatment option, heparin, as low AT III levels render heparin ineffective.

How is fibrinogen used in managing thrombolytic therapy in DVT patients?

Fibrinogen serves as an index of the systemic thrombolytic status and an indicator of the bleeding risk associated with thrombolysis. During local thrombolytic therapy, if serum fibrinogen levels drop, it indicates an increased risk of bleeding complications. In most cases, the thrombolytic dose is reduced when fibrinogen levels fall to 1 g/l and treatment is discontinued if levels reach 0.5 g/l to prevent excessive bleeding.

What is the significance of these diagnostic procedures in the overall management of DVT?

These diagnostic procedures are vital for accurately diagnosing DVT, assessing the thrombotic and inflammatory status of patients, and guiding effective treatment plans. By using tests like D-dimer, AT III, and fibrinogen levels, healthcare professionals can make informed decisions about anticoagulation therapy, monitor treatment efficacy, and minimise the risk of complications.