Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism.
BACKGROUND
We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE).


PATIENTS AND METHODS
We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis.


RESULTS
PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88-100 %)/95 % (95 % CI, 88-100 %) and 95 % (95 % CI, 88-100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21-37 %) for D-dimer and 24.4 % (95 % CI, 17-33 %) for tPA.


CONCLUSIONS
The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.
['Flores|Julio|J|', 'García-Avello|Angel|A|', 'Alonso|Esther|E|', 'Ruíz|Antonio|A|', 'Navarrete|Olga|O|', 'Alvarez|Concepción|C|', 'Lozano|Cristina|C|', 'Arribas|Ignacio|I|']
D000208:Acute Disease D000328:Adult D000368:Aged D000369:Aged, 80 and over D019540:Area Under Curve D015415:Biomarkers D003952:Diagnostic Imaging D004797:Enzyme-Linked Immunosorbent Assay D005260:Female D005338:Fibrin Fibrinogen Degradation Products D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D011655:Pulmonary Embolism D012372:ROC Curve D015203:Reproducibility of Results D010959:Tissue Plasminogen Activator
tissue plasminogen activator tPA D-dimer diagnostic utility Pulmonary embolism diagnosis