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Vincent Falanga, MD; Jonathan Kruskal, MB, ChB; John J. Franks, MD

Arch Dermatol. 1991;127(1):75-78.

Abstract
• Abnormalities in systemic fibrinolysis have been implicated in the pathogenesis of venous ulceration. Patients with venous disease have a prolonged euglobulin lysis time and elevated plasma fibrinogen levels, yet little is known about the metabolism of fibrinogen and fibrin in such patients. In this study, we have used a technique that involves electrophoresis and densitometric analysis of captured fibrin-related antigens to measure the concentration and proportions of the individual fibrin and fibrinogen degradation products in patients with venous disease of the lower extremity. As a group, patients with venous disease had markedly elevated levels of total fibrin-related antigen and D-dimer, the terminal degradation product of cross-linked fibrin. Levels of D-monomer, the breakdown product of fibrinogen and non-cross-linked fibrin monomer, and a measure of fibrinogenolysis were normal in all patients. In patients with ulcers, the levels of D-dimer were disproportionately higher than expected from fibrin monomer levels. On an individual basis, significant elevations of D-dimer were present in six (55%) of the 11 patients with venous disease with ulcers and in three (43%) of the seven patients with venous disease without ulcers. We conclude that patients with venous disease have uniform evidence for enhanced fibrin formation, as evidenced by elevated levels of total fibrin-related antigen and D-dimer. This is regardless of whether the venous disease is accompanied by ulceration.

(Arch Dermatol. 1991;127:75-78)

Author Affiliations
From the Department of Dermatology and Cutaneous Surgery, University of Miami (Fla) School of Medicine (Dr Falanga), and Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tenn (Drs Kruskal and Franks). Dr Kruskal is now with the Department of Radiology, New England Deaconess Hospital, Boston, Mass.

Footnotes
Accepted for publication August 28, 1990.

Reprint requests to Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, PO Box 016250 (R-250), Miami, FL 33101 (Dr Falanga).

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