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Among diabetic patients the presence of a nephropathy is associated with an increased risk of cardiovascular disease. But the prevalence and importance of the classical risk factors of cardiovascular disease among these patients do not appear to fully explain this phenomenon. An impaired fibrinolysis has been shown to be a risk factor for coronary heart disease. Therefore we have studied the fibrinolysis parameters in 31 insulin dependent diabetic patients subdivided in three groups according to their urinary albumin excretion (UAE), in normal (11 patients with UAE

In 100 consecutive patients with clinically suspected deep vein thrombosis (DVT) of the legs, plasma D-dimer measurements based on an enzyme linked immunosorbent assay (ELISA) and on latex agglutination (Diagnostica Stago) were compared to the results of real time B mode ultrasound imaging combined with Doppler examination, which in a previous study has proved to be a very accurate method competitive with venography for the diagnosis of DVT. Forty five patients had DVT identified with the ultrasonic tests. We have obtained for ELISA and latex tests of D-dimer respectively: accuracy: 60%, 56%; sensitivity: 98%, 98%; specificity: 29%, 22%; predictive value of a positive test: 53%, 50% and predictive value of a negative test: 94%, 92%. These results confirmed those of previous studies using ELISA or latex assays, with venography as a reference test. We conclude that a negative D-dimer test, defined by a value lower than 0.5 μg/ml, excludes the diagnosis of DVT in 94% of cases by ELISA method and in 92% of cases by latex method. A reduction of venography or other objective testing of the venous circulation could be obtained if these methods were not performed in the case of a negative D-dimer test. However the safety of withholding anticoagulant therapy in out patients with negative tests needs confirmation in a prospective trial.

Thirty patients with deep venous thrombosis (DVT) (less than 7 days) were randomised into three treatment groups and received Choay's CY222 at the respective doses of 4 mg (group I), 3 mg (group II) and 2 mg/kg/24 h (group III) administered in three subcutaneous injections. A relationship between the thrombolytic effect evaluated on phlebography and plasma fibrinolysis parameters was looked for. Phlebography was performed before (D0) and on Day 7 (D7) of treatment and scored by Marder's index (MI). The mean decrease in MI on D7 was 40%. Blood samples were taken at DO and at 8.00 am before injection on D1, D3, D5 and D7. The following fibrinolysis parameters: euglobulin fibrinolytic activity (EFA), t-PA-Ag, PA inhibitor (PAI), showed no change during treatment in each group. Among patients with MI > 10 on DO (n=24) two response groups, A and B, were distinguished, based upon the thrombolytic response: Group A — six patients (three in treatment group I, two in group II and one in group III) with high degree of thrombolysis (decrease in MI ⩾ 80%); Group B — nine patients (three in each treatment group) with no thrombolytic response (decrease in MI ⩽ 20%). Changes in plasma fibrinolysis parameters in Groups A and B showed no difference during treatment. On DO mean PAI was lower in Group A than in Group B (p 4 U/ml) (5 of 30) before and during treatment were in Group B. These results show that CY222 is effective in the treatment of DVT. Its mechanism of action remains unclear, as no direct effect on EFA, t-PA-Ag, and PAI level could be demonstrated. No thrombolysis occured in patients with high PAI before treatment. Thus pre-treatment determination of PAI could have a predictive value in the efficacy of CY222 treatment.