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Assembly and routing of von Willebrand factor variants: the requirements for disulfide-linked dimerization reside within the carboxy-terminal 151 amino acids.

The precursor protein of von Willebrand factor (pro-vWF) consists of four different repeated domains, denoted D1-D2-D'-D3-A1-A2-A3-D4-B1-B2-B3-C1-C2, followed by a carboxy-terminal region of 151 amino acids without obvious internal homology. Previously, we have shown the requirement of the domains D1, D2, D', and D3 of pro-vWF in the assembly of pro-vWF dimers into multimers. Here, we define the domains of vWF involved in dimerization, using deletion mutants of full-length vWF cDNA transiently expressed in monkey kidney COS-1 cells. It is shown that only the carboxy-terminal 151 amino acid residues of vWF are required for dimerization. In addition, by analyzing a construct, encoding only the carboxy-terminal 151 amino acids of vWF, we find that the formation of dimers is an event independent of other domains present on pro-vWF, such as the domains C1 and C2 previously suggested to be involved in dimerization. Furthermore, it is shown that a deletion mutant of vWF, lacking the carboxy-terminal 151 amino acid residues and thus unable to dimerize, is proteolytically degraded in the ER. In contrast, a mutant protein, composed only of the carboxy-terminal 151 amino acids of vWF, and able to dimerize, is transported from the ER in a similar fashion as wild-type vWF. The role of the ER in the assembly of vWF is discussed with regard to the data presented in this paper on the intracellular fate of several vWF mutant proteins.

Animals↗

The requirement for DM in class II-restricted antigen presentation and SDS-stable dimer formation is allele and species dependent.

Recently several cell lines have been identified with mutations in a major histocompatibility complex (MHC)-linked protein that lead to defects in class II-restricted antigen presentation and a defect in the formation of class II SDS-stable dimers. The defect in these cells has recently been shown to result from the inability to express the MHC-encoded nonclassical class II molecule called DM. To further examine the role of DM in class II-restricted antigen presentation, we asked if this defect would equally affect different allelic and species variants of class II molecules. To investigate this, we transfected the parent cell lines T1 and 8.1.6 and their respective antigen presentation mutants T2 and 9.5.3 with the genes encoding I-Ad and examined the derived transfectants for their ability to present antigen, the conformation of I-Ad at the cell surface, association of I-Ad with invariant chain (Ii), and the ability to form I-Ad SDS-stable dimers. The lack of functional DM expression did not affect any of the anti-I-Ad monoclonal antibody (mAb) epitopes tested or the ability of I-Ad to associate and dissociate with Ii. Surprisingly, these studies also revealed that the antigen presentation defect observed for DR in the 9.5.3 cells did not compromise I-Ad-restricted antigen presentation. In addition, we found that the level of SDS-stable dimer formation did not correlate with antigen presentation capacity for I-Ad and that the amount of SDS-stable I-Ad dimer depends on the cellular context in which the class II molecule is expressed. Our results suggest that the ability to form SDS-stable dimer is not strictly correlated with class II-restricted antigen presentation. Finally, when two allelic forms of murine class II molecules were compared in the defective T2 cell line, it was found that I-Ak but not I-Ad forms SDS-stable dimers equivalent to that seen in the parental cell lines. Overall, our results suggest that DM may modulate rather than play a requisite role in I-Ad-restricted antigen presentation and SDS-stable dimer formation and that dependency on DM may be allele or species specific.

Animals↗

Induction, repair and accumulation of thymine dimers in the skin of UV-B-irradiated hairless mice.

A monoclonal antibody specific for cyclobutane thymine dimers in DNA was used in immunofluorescence studies to detect these lesions in skin sections taken from hairless mice that had been irradiated with UV-B. The dimer-specific fluorescence in epidermal cell nuclei was quantified with fluorescence microscopy through computer-mediated image processing and analysis. After a UV-dose of 500 J/m2, thymine dimers could easily be detected. Rapid removal of these lesions in vivo was observed during the first 4 h after exposure, but at 24 h approximately 40% of the dimers still persisted. Thymine dimers accumulated in the skin of mice subjected chronically to a dose regimen of 1000 J/m2 UV-B per day. In the first week strong accumulation of dimers was observed. At day 3 to 4 it reached a maximum, after which a decrease to a more constant level occurred. Concomitant with this decrease the number of epidermal cell layers increased after the first week. After 3 months of irradiation, mice started to develop skin tumors. At that time point the epidermis had thickened to contain up to 10 cell layers, compared to 1-2 layers in unirradiated mice, but thymine dimers were still induced.

Animals↗

D-dimer and fibrinolysis in patients with various degrees of atherosclerosis.

D-dimer, plasminogen activator inhibitor (PAI-1) activity at rest and after exercise, and tissue plasminogen activator (t-PA) activity after exercise were measured in venous blood in 88 patients with atherosclerotic lesions of various degrees. According to clinical symptoms, coronary angiography (CAG), ultrasound Doppler signal and duplex and colour Doppler scanning of carotid arteries and their branches, subclavian, vertebral and peripheral arteries of the lower limbs, patients were divided into four groups. Group 1, 16 men without CAG and ultrasound signs of atherosclerotic lesions; group 2, 27 patients with CAG-confirmed coronary artery disease; group 3, 18 patients with peripheral artery occlusive disease; group 4, 27 patients with coexistence of two or more regions of atherosclerotic lesions. D-dimer was the highest in patients with the most extensive atherosclerosis: 432 +/- 164 ng.ml-1 in group 3, 429 +/- 98 ng.ml-1 in group 4 vs 163 +/- 25 ng.ml-1 in group 1, P < 0.05. There were correlations (P < 0.05) between: age and D-dimer (r = 0.29); D-dimer and t-PA (r = 0.34); D-dimer and PAI-1, r = -0.29. Patients were also analysed according to D-dimer level. In patients with the highest level of D-dimer, the lowest level of PAI-1 activity and the highest level of t-PA activity after exercise were observed. The low PAI-1 activity is probably the result of an increased release of t-PA in these patients.

Adult↗

A rapid quantitative D-dimer assay at admission correlates with the severity of community acquired pneumonia.

Previous research has shown a link between infectious inflammatory processes and hemostatic abnormalities. No data exist, however, on whether coagulation markers correlate with the severity of community-acquired pneumonia (CAP) at admission. We conducted a prospective, observational study in an Emergency Medicine Department of a primary care hospital. Sixty-eight patients admitted with CAP were included. Blood samples were collected at admission and assayed for D-dimer levels. D-dimers were correlated with the Pneumonia Patient Outcome Research Team (PORT) score and Acute Physiology and Chronic Health Evaluation II score on admission, with length of hospital stay, number of organ failures, time to defervescence and hospital mortality. D-dimer levels were positively correlated with the Acute Physiology and Chronic Health Evaluation II score (r = 0.44, P = 0.0002), the PORT score (r = 0.36, P = 0.002) and the length of hospital stay (r = 0.24, P = 0.046). Mean D-dimer levels of patients for whom hospitalization is recommended, according to PORT guidelines, were significantly higher than D-dimer levels of patients for whom hospitalization is not recommended (1.47 +/- 1.05 microg/ml and 0.71 +/- 0.79 microg/ml respectively; P = 0.006). The correlation between D-dimer levels and time to defervescence, development of organ system failure and outcome was not statistically significant. We conclude that D-dimer levels at admission may predict the severity of CAP.

Aged↗

Plasmin generation and D-dimer formation during cardiopulmonary bypass.

The purpose of this study was to estimate the in vivo rates of plasmin and D-dimer generation for comparison with the rate of fibrin formation during cardiopulmonary bypass (CPB), a procedure known to induce a hyperfibrinolytic state. Plasmin and D-dimer generation rates were based on measured levels of antiplasmin, plasmin-antiplasmin complex and D-dimer obtained before, during and after CPB from nine males, combined with a computer model of each patient's vascular system that continuously accounted for secretion, clearance, hemodilution, blood loss and transfusion. At baseline the average plasmin and D-dimer generation rates were 0.27 +/- 0.07 and 0.18 +/- 0.07 pmol/s, respectively. Within 5 min of CPB initiation, plasmin generation increased over 100-fold to 36 +/- 40 pmol/s while D-dimer generation increased 200-fold to 37 +/- 39 pmol/s. For the remainder of the CPB, average plasmin and D-dimer generation remained 20-fold to 30-fold above baseline levels. During CPB, the rate of D-dimer generation was similar to the rate of total fibrin formation, indicating that, in the absence of fibrinolytic inhibitors, CPB induces plasmin-mediated removal of fibrin from the vascular system at a rate similar to the rate of fibrin formation.

Aged↗

Coagulative disorders in human acute pancreatitis: role for the D-dimer.

INTRODUCTION AND AIMS: We investigated coagulative disorders, particularly the role of the D-dimer, in acute pancreatitis where coagulation abnormalities related to disease severity are known to occur. METHODOLOGY: D-dimer levels in 30 patients with acute pancreatitis were evaluated; pancreatitis was mild and uncomplicated in 11 patients, accompanied by complications in 15, and severe in 4. We attempted to find a relationship between the D-dimer level and the antithrombin III level, prothrombin time, partial thromboplastin time, the C-reactive protein level, and results of routine laboratory tests. RESULTS: In the 11 patients with uncomplicated pancreatitis, the D-dimer level increased about 1.5 times over the limit, while in the 15 patients with complications and the four patients with severe pancreatitis, the D-dimer level increased about seven times above the normal limit; this difference was highly significant (p < 0.0001). The rise in the D-dimer level was inversely related to albumin and calcium levels (p = 0.0001) and directly related to the C-reactive protein level, fibrinogen level and leukocyte count (p = 0.0001), prothrombin time (p = 0.006), partial thromboplastin time (p = 0.03), and acute abdominal collections and lung involvement (p = 0.0001). The increase appeared early on, lasting for the entire study and peaking on days 3-6. CONCLUSIONS: The D-dimer is the expression of pancreatitis and the extension of systemic involvement; it may be considered a prominent link in the chain of events leading to severe disease.

Aged↗

D-dimer test for early detection of HELLP syndrome.

We attempted to predict patients at risk for HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) by using the D-dimer test to screen 81 preeclamptic gravidas and 12 control subjects. Among preeclamptic patients, 43 had positive and 38 had negative results of D-dimer tests. All controls had negative results. Women with positive results had significantly higher mean arterial pressures at admission and postpartum, lower platelet counts, and elevated liver enzyme values. D-dimer-positive women also had infants with significantly lower birth weight and lower Apgar scores. After delivery, those with a positive D-dimer test were at risk for even greater abnormalities of liver enzymes, as well as lower platelet counts. Abnormalities of any of these laboratory parameters were unlikely in the presence of a negative D-dimer test result (negative predictive value = 0.89). Our results suggest that D-dimer-positive preeclamptic women are at high risk of having HELLP syndrome and should receive close follow-up, whereas D-dimer-negative patients are unlikely to have this disorder and tend to have a better maternal-fetal outcome.

Apgar Score↗

Deep venous thrombosis: prediction by D-dimer?

The utility of D-dimer as an inexpensive, noninvasive method of diagnosing deep venous thrombosis (DVT) is debated. We sought to determine whether a qualitative D-dimer assay would have a high correlation with DVT in 65 hospitalized patients who were randomly referred for diagnosis of DVT by venous duplex and duplex Doppler ultrasonography. Patients were excluded from the study if they had any inflammatory, infectious, or malignant condition associated with elevation of D-dimer. The mean level of D-dimer in patients with DVT (16 of 65 patients) was 5,141 ng/mL, compared with 3,024 ng/mL in those without DVT, but there was considerable overlap between the two groups. No patients with a D-dimer level < 2,000 ng/mL had DVT. We conclude that the qualitative D-dimer assay is an excellent exclusionary test for DVT at levels less than 2,000 ng/mL. Limitations of the D-dimer assay and cost-effective issues are discussed.

Adolescent↗

Specificity determinants for the interaction of lambda repressor and P22 repressor dimers.

The related phage lambda and phage P22 repressors each bind cooperatively to adjacent and separated operator sites, an interaction that involves a pair of repressor dimers. The specificities of these interactions differ: Each dimer interacts with its own type but not with dimers of the heterologous repressor. The two repressors exhibit significant amino acid sequence homology in their carboxy-terminal domains, which are responsible for both dimer formation and the dimer-dimer interaction. Here, we identify a collection of amino acid substitutions that disrupt the protein-protein interaction of DNA-bound lambda repressor dimers and show that several of these substitutions have the same effect when introduced at the corresponding positions of P22 repressor. We use this information to construct a variant of the lambda repressor bearing only six non-wild-type amino acids that has a switched specificity; that is, it binds cooperatively with P22 repressor, but not with wild-type lambda repressor. These results identify a series of residues that determine the specificities of the two interactions.

Amino Acid Sequence↗

Dimethyl sulfoxide at 2.5% (v/v) alters the structural cooperativity and unfolding mechanism of dimeric bacterial NAD+ synthetase.

Dimethyl sulfoxide (DMSO) is commonly used as a cosolvent to improve the aqueous solubility of small organic compounds. Its use in a screen to identify novel inhibitors of the enzyme NAD(+) synthetase led to this investigation of its potential effects on the structure and stability of this 60-kD homodimeric enzyme. Although no effects are observed on the enzyme's catalytic activity, as low as 2.5% (v/v) DMSO led to demonstrable changes in the stability of the dimer and its unfolding mechanism. In the absence of DMSO, the dimer behaves hydrodynamically as a single ideal species, as determined by equilibrium analytical ultracentrifugation, and thermally unfolds according to a two-state dissociative mechanism, based on analysis by differential scanning calorimetry (DSC). In the presence of 2.5% (v/v) DMSO, an equilibrium between the dimer and monomer is now detectable with a measured dimer association constant, K(a), equal to 5.6 x 10(6)/M. DSC curve analysis is consistent with this finding. The data are best fit to a three-state sequential unfolding mechanism, most likely representing folded dimer <==> folded monomer <==> unfolded monomer. The unusually large change in the relative stabilities of dimer and monomer, e.g., the association equilibrium shifts from an infinitely large K(a) down to approximately 10(6)/M, in the presence of relatively low cosolvent concentration is surprising in view of the significant buried surface area at the dimer interface, roughly 20% of the surface area of each monomer is buried. A hypothetical structural mechanism to explain this effect is presented.

Algorithms↗

A comparative evaluation of assays for markers of activated coagulation and/or fibrinolysis: thrombin-antithrombin complex, D-dimer and fibrinogen/fibrin fragment E antigen.

Measurements were made of levels of D-dimer in plasma and serum, thrombin-antithrombin complex (TAT) in plasma and fibrinogen/fibrin fragment E antigen (FgE) in serum in a normal healthy control group and in patients with a range of disorders associated with hypercoagulability. Levels were determined in 31 normal healthy controls, 30 patients with disseminated intravascular coagulation (DIC), 21 patients with deep venous thrombosis (DVT), 27 patients with myocardial infarction (MI), 26 patients with acute leukaemia and 56 patients with liver disease. Considering all subjects, significant correlations were established between the results of all assays. Notably high correlations (r greater than 0.9) were established between plasma and serum levels of D-dimer, between plasma levels of D-dimer and serum levels of FgE, and between serum levels of D-dimer and FgE. All assays showed very high discrimination (sensitivity) between the normal control group and patients with DIC (97-100%), but there were marked differences between the assays in sensitivity for DVT and MI. In general, the FgE assay was more sensitive than the D-dimer assay, whilst both the FgE and D-dimer assays were more sensitive than the TAT assay. The same trends were apparent in the capability of the assays to discriminate between the normal control group and patients with acute leukaemia and liver disease: disorders with an unknown prevalence of activation of coagulation/fibrinolysis. Our results indicated that measurements of fibrinogen/fibrin degradation products (FDPs) in serum were almost unaffected by artefacts. The data further suggested that the broad-spectrum FgE assay was better than the more specific D-dimer assay in detecting clinical hypercoagulability. Our study showed that, in the clinical conditions examined, FDPs were more effective markers of hypercoagulability than TAT.

Acute Disease↗

Purification and properties of D(-)-3-hydroxybutyrate-dimer hydrolase from Zoogloea ramigera I-16-M.

D(-)-3-Hydroxybutyrate-dimer hydrolase from Zoogloea ramigera I-16-M was purified 7000-fold to electrophoretic homogeneity. The molecular weight of the purified enzyme was 28 000 as determined by Sephadex G-100 gel filtration, and 30 000 as estimated by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. The isoelectric point was at pH 5.7. The pH optimum for the enzyme reaction was 8.0. The dimer hydrolase was stereospecific for D(-)-3-[D(-)-3-hydroxybutyryloxy]butyric acid (DD-dimer) but also hydrolyzed D(-)-3-[L(+)-3-hydroxybutyryloxy]butyric acid (DL-dimmer) and L(+)-3-[D(-)-3-hydroxybutyryloxy]butyric acid (LD-dimer) at reduced rates. However, the enzyme did not attack L(+)-3-[L(+)-3-hydroxybutyryloxy]butyric acid (LL-dimer) at all. In addition, the purified hydrolase hydrolyzed several oligomeric esters of D(-)-3-hydroxybutyric acid (DDD-dimer, DDDD-tetramer and DDDDD-pentamer) faster than DD-dimer. Time course experiments with these oligomers and analysis of hydrolytic products of DDD-tetramer methyl ester with the hydrolase indicated that the enzyme attached these substrates from the free hydroxyl terminus releasing monomer units one at a time.

Carboxylic Ester Hydrolases↗

Dimerization of deoxyribonuclease I, lysozyme and papain. Effects of ionic strength on enzymic activity.

Transition of bovine ribonuclease A from its monomeric to a dimeric form changes the pattern of enzymic activity response to ionic strength [Sorrentino, S., Carsana, A., Furia, A., Doskocil, J., and Libonati, M. (1980) Biochim. Biophys. Acta. 609, 40-52]. To see whether this phenomenon could be common to other enzyme-substrate systems, the action of various dimeric and monomeric enzymes (ox pancreas deoxyribonuclease, hog spleen acid deoxyribonuclease, bovine seminal ribonuclease, egg-white lysozyme, and papain) on polyelectrolytic substrates has been studied under different conditions of ionic strength. Dimerization of ox pancreas deoxyribonuclease, lysozyme and papain was obtained by cross-linkage with dimethyl suberimidate. The main results of the investigation, similar to those obtained with ribonuclease A, are the following. 1. Enzyme monomers and dimers show markedly different patterns of activity response to ionic strength at given pH values: the reactions catalyzed by monomeric enzymes are highly modulated by salt, whereas those catalyzed by dimeric enzymes are not. In particular, at the reaction optimum the monomeric form of an enzyme is significantly more active than the dimeric one. 2. The optimum of the reaction catalyzed by a dimeric enzyme is shifted to higher ionic strengths in comparison with that of the reaction catalyzed by a monomeric enzyme. A model is proposed that could explain these results on the basis of the influence of ionic strength on the intramolecular dynamics of the enzyme molecule and its non-specific interactions with polyelectrolytic substrates.

Animals↗

Rapid equilibrium between monomeric, dimeric and tetrameric forms of the 46-kDa mannose 6-phosphate receptor at 37 degrees C. Possible relation to the function of the receptor.

At 4 degrees C, detergent-solubilized 46-kDa mannose 6-phosphate receptor (MPR 46) exists as a mixture of dimeric and tetrameric forms [A. Waheed, A. Hille, U. Junghans & K. von Figura (1990) Biochemistry 29, 2449-2455]. At 37 degrees C, MPR 46 exists as a mixture of monomeric, dimeric and tetrameric forms, which can be separated by sucrose density centrifugation or chromatography on a mannose-6-phosphate affinity matrix. Monomeric MPR 46 did not bind to the affinity matrix, while dimeric and tetrameric receptors were eluted with increasing concentrations of mannose 6-phosphate. Depending on the incubation temperature, dimeric MPR 46 preferentially associates to tetramers (less than or equal to 16 degrees C) or dissociates to monomers (greater than or equal to 25 degrees C). The presence of mannose 6-phosphate shifts the equilibrium to higher quaternary structure, with a maximal effect at 37 degrees C. Incubation of dimeric or tetrameric receptor at pH 4.0 induces a rapid dissociation of about a third of the receptor with t1/2 of less than 2 min, followed by a phase of slow dissociation. Readjusting the pH to 7.5 induces a rapid formation of dimers and tetramers, which is promoted by the presence of mannose 6-phosphate or an increase of the receptor concentration. These observations may indicate that the recycling of the receptor between the Golgi apparatus, where it binds ligands at near-neutral pH, and the acidic prelysosomes, where it releases the ligands, is associated with a change of its quaternary structure, which in turn may affect the recycling kinetics. In keeping with this assumption, we observed in baby hamster kidney cells over-expressing MPR 46 and in membrane prepared from these cells monomeric, dimeric and tetrameric forms of the receptor.

Animals↗

Recombinant anti-sialidase single-chain variable fragment antibody. Characterization, formation of dimer and higher-molecular-mass multimers and the solution of the crystal structure of the single-chain variable fragment/sialidase complex.

The single-chain antibody variable fragment (scFv), with a 15-residue polypeptide linker (Gly4Ser)3, of monoclonal antibody NC10 was expressed in Escherichia coli and purified to homogeneity. This scFv molecule, refolded from 6 M guanidine hydrochloride, was predominantly a monomer of 27 kDa and was stable on storage at 4 degrees and 20 degrees C. At higher protein concentrations (approximately 5 mg/ml) dimer and higher-molecular-mass multimers were formed and freezing enhanced this aggregation. The dimer was not stable and dissociated to monomer at 20 degrees C with a half-life of approximately 8 days. The higher-molecular-mass multimers and dimer dissociated to monomer in 60% ethylene glycol. Both the monomer and dimer were active and with tern N9 sialidase yielded complexes of 276 kDa and 569 kDa, respectively, indicating that four scFv molecules bound/sialidase tetramer and that the dimer was bivalent and cross-linked two sialidase tetramers. Binding studies at low concentrations and using radiolabelled scFv indicated that the binding affinity of the dimer was approximately twofold higher than that of the monomer, and the binding affinities of the scFv were similar to that of the parent NC10 antigen-binding fragment (Fab) molecule. A complex between tern N9 sialidase and NC10 scFv was crystallized and the structure of the complex was solved at 0.3-nm resolution by X-ray diffraction. Comparison of this scFv/sialidase structure with the parent Fab/sialidase structure revealed that the modes of attachment of scFv and Fab to sialidase were very similar. There was no discernible electron density for the peptide linker joining the variable heavy (VH) and variable light (VL) chains. A close interaction between two symmetry-related scFv suggests that they may have crystallized as dimers.

Animals↗

Stimulation of phospholipase C-beta 2 by recombinant guanine-nucleotide-binding protein beta gamma dimers produced in a baculovirus/insect cell expression system. Requirement of gamma-subunit isoprenylation for stimulation of phospholipase C.

Recombinant wild-type beta 1 gamma 1 dimers of signal-transducing guanine nucleotide-binding proteins (G proteins) and beta 1 gamma 1 dimers carrying a mutation known to block gamma-subunit isoprenylation (beta 1 gamma 1 C71S) were expressed in baculovirus-infected insect cells. Both wild-type and mutant beta 1 gamma 1 dimers were found in soluble fractions of infected cells upon subcellular fractionation. Anion exchange chromatographic and metabolic-radiolabeling studies revealed that the soluble beta 1 gamma 1 preparation contained approximately equal amounts of non-isoprenylated and isoprenylated beta 1 gamma 1 dimers. Soluble wild-type and mutant beta 1 gamma 1 dimers and native beta 1 gamma 1 dimers purified from bovine retina were reconstituted with recombinant phospholipase C-beta 2. Only isoprenylated beta 1 gamma 1 dimers were capable of stimulating phospholipase C-beta 2. The results show that gamma-subunit isoprenylation and/or additional post-translational processing of the protein are required for beta gamma subunit stimulation of phospholipase C.

Animals↗

Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis.

BACKGROUND: Fibrin-related markers such as soluble fibrin (SF) and D-dimer are considered useful for the diagnosis of thrombosis. However, the evidence for diagnosis of thrombosis by fibrin-related markers is not well-established. OBJECTIVE: To evaluate the cutoff values of D-dimer and SF in the diagnosis of thrombosis. PATIENTS AND METHODS: Plasma concentrations of SF and D-dimer were measured in 784 inpatients suspected of having thrombosis between 1 August 2003 and 31 December 2004, and then correlated with thrombosis. RESULTS AND CONCLUSIONS: Plasma concentrations of D-dimer and SF were significantly higher in patients with disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT) and cerebral thrombosis, compared with those in patients without thrombosis. When cutoff values of > 3.0 microg mL(-1) for D-dimer and > 6.0 microg mL(-1) for SF were used for the diagnosis, more than 50% of patients (with the exception of liver transplant patients and postoperative patients) had thrombosis. Receiver operating characteristic analysis showed that SF was more useful than D-dimer for the diagnosis of thrombosis (i.e. DVT and DIC). The cutoff value of D-dimer (7.87 microg mL(-1)) was the same for DVT and DIC, while that of SF was slightly lower for DVT (7.05 microg mL(-1)) than for DIC (8.60 microg mL(-1)). Our findings suggest that high levels of plasma fibrin-related markers reflect high risk for thrombosis.

Aged↗