Uriny prothrombin fragments (F1 + 2) as a diagnostic tool for venous thrombo-embolism and myocardial infarction: A pilot study

Objective: Clinical decision rules and D-dimer test are used to exclude venous thromboembolism (VTE), whereas troponin reliably predicts the risk of myocardial infarction (MI). In case of thrombotic events, prothrombin activation is increased and prothrombin fragment 1 + 2 (F1 + 2) is excreted in the urine. We analysed whether urine F1 + 2 levels are elevated in VTE and MI, and could be used to exclude thrombotic events in patients suspected of venous or arterial thrombotic events. Methods: In 20 patients with VTE, 20 with MI, and 25 controls, F1 + 2 and D-dimer were measured in urine and plasma within 48 h after diagnosis. Results: Twelve men and eight women with VTE were included with a mean age of 58 years, for the MI group this was 13 and seven respectively with a mean age of 62 years. Patients were matched to healthy controls by age and gender. In patients with VTE, both plasma and urine F1 + 2 levels were higher than in controls, whereas for MI no apparent differences were found. D-dimer levels in urine were very low in all groups (table). Conclusion: This study suggests higher urine F1 + 2 levels in patients with VTE. As urine sampling is patient friendly, the predictive value of urine F1 + 2 in the exclusion of VTE should be further explored. Adjustment for kreatinin and albumin concentration in urine may improve the diagnostic characteristics.