Evaluate The Diagnostic Value Of D-dimer And Other Coagulation Indexes In Acute DVT Catheter-directed Thrombolysis By ROC Curve

ObjectiveTo analyze the dynamic changes of plasma D-dimer and fibrinogen in the course of DVT and the significance of ROC curve.MethodsFrom December 2018 to June 2019,84 patients with acute DVT were selected,including 41 male,43 female,59 central type and 25 mixed type,74 left lower limbs,9 right lower limbs and 1 double lower limbs.All patients were treated with IVC filter and ultrasound-guided thrombolysis via popliteal vein catheter.The initial dose of 200000 u urokinase was added into 50 ml 0.9% normal saline,and thrombolysis was directly pumped every 8 hours.At the same time,low molecular weight heparin calcium 100 U / kg body weight was injected subcutaneously every 12 hours.Patients in the group received catheter angiography after thrombolysis,if the stenosis of iliac vein is found to be serious,the patients should be treated by endovascular treatment after thrombolysis,such as percutaneous transluminal angioplasty or combined stent placement.The complications and adverse reactions were observed,and the significance of plasma D-dimer and FIB in the treatment was analyzed.ResultsThe complication rate of patients was 7.14%(6/84).The level of D-dimer increased gradually after thrombolysis,and began to decrease on the third day.The AUC of D-dimer was 0.91,indicating high accuracy.The cutoff value was 39.50mg/l,the sensitivity was 96.6%,and the specificity was 87.8%.Combined with the trend chart of D-dimer,it can be seen that the D-dimer is in the rising trend and reaches the peak in the first two days after the start of thrombolysis,,so that individual patients reach and exceed the cutoff value of 39.50mg/l.Therefore,it is necessary to judge the thrombolytic effect and vascular patency by this cutoff value after the third day of thrombolysis.The AUC of other coagulation indexes were: FIB 0.74,INR 0.59,prothrombin activity 0.47,APTT 0.52,prothrombin time 0.50,thrombin time0.43,in which the area under FIB curve is more than 0.70 but less than 0.90,which only has a certain accuracy and has no higher clinical significance;while the other indicators have little clinical significance,so no further analysis is carried out.ConclusionD-dimer can be used as a reliable basis to evaluate the patency of blood vessels and the adjustment of treatment plan after acute DVT catheterization and thrombolysis combined with anticoagulation.According to the changes of D-dimer in the treatment,it can provide the basis for DVT individual thrombolysis.