Clots - D-dimer & CRP.

[pjoshea13]

New study below.

Some might recall that I have written quite a bit about altered coagulation in PCa & its potential role in metastasis.

When I was diagnosed with a double DVT in my left calf, my doctor said that I would be on Warfarin for 6 months - 3 months for a first offender plus 3 months because I had cancer. He agreed to 3 months if I would get a repeat ultrasound scan. When only one DVT had cleared, he agreed to let me try nattokinase & monitor with periodic D-dimer tests.

The new study involved people with cancer-associated thrombosis (CAT) who were treated with "≥3 months of anticoagulation that was subsequently discontinued".

They monitored D-dimer & C-reactive protein (a measure of inflammation - another of my favorite topics).

D-dimer is elevated when a fibrin clot is being broken down by plasmin (or by nattokinase). It can be elevated for another reason, but zero means no clot.

"The DD and hs-CRP levels after 21 days were associated with VTE recurrence."

This is great news for those who wish to stop anticoagulation. It gives them a safe approach. Currently, most find out about VTE recurrence in the ER.

But, importantly for men with PCa, it may help prevent that first visit to the ER.

I posted a series on the importance of controlling inflammation. CRP should be brought as close to zero as possible. CRP has an impact on mortality risk even where there is no diagnosed disease.

With cancer, one should assume that an elevated D-dimer is due to a clot (that is the assumption in the ER if a clot is suspected.)

My own approach is to use nattokinase to reduce D-dimer to zero. I will never go back on Warfarin.

But in any case, the tests can give one a timely heads-up. Too many die on the way to the ER.

-Patrick

ncbi.nlm.nih.gov/pubmed/303...

Br J Cancer. 2018 Oct 15. doi: 10.1038/s41416-018-0269-5. [Epub ahead of print]

D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis.

Jara-Palomares L1,2, Solier-Lopez A3, Elias-Hernandez T3, Asensio-Cruz MI3, Blasco-Esquivias I4, Sanchez-Lopez V5, de la Borbolla MR6, Arellano-Orden E5, Suarez-Valdivia L3, Marin-Romero S3, Marin-Barrera L3, Ruiz-Garcia A7, Montero-Romero E7, Navarro-Herrero S8, Lopez-Campos JL3,9, Serrano-Gotarredona MP8, Praena-Fernandez JM10, Sanchez-Diaz JM11, Otero-Candelera R3.

Author information

1

Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain. [e-mail].

2

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [e-mail].

3

Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain.

4

Internal Medicine, Emergency Service, Virgen Macarena Hospital, Seville, Spain.

5

Institute of Biomedicine of Seville (IBIS), Virgen del Rocío Hospital, Seville, Spain.

6

Medical Oncology, Virgen de Valme Hospital, Seville, Spain.

7

UGC Emergency Service, Virgen del Rocío Hospital, Seville, Spain.

8

Diagnostic Imaging Unit, Radiology Service, Virgen del Rocío Hospital, Seville, Spain.

9

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

10

Methodology and Research Evaluation Unit, Hospital Virgen del Rocío, Seville, Spain.

11

Pharmacy, Hospital Virgen del Rocío, Seville, Spain.

Abstract

BACKGROUND:

Optimal duration of anticoagulation for cancer-associated thrombosis (CAT) remains unclear. This study assessed D-dimer (DD) and high-sensitivity C-reactive protein (hs-CRP) levels after the withdrawal of anticoagulation treatment to predict the risk of venous thromboembolism (VTE) recurrence among patients with CAT.

METHODS:

Prospective, multicentre study to evaluate CAT with ≥3 months of anticoagulation that was subsequently discontinued. Blood samples were taken when patients stopped the anticoagulation and 21 days later to determine the DD and hs-CRP levels. All patients were followed up for 6 months to detect VTE recurrence.

RESULTS:

Between 2013 and 2015, 325 patients were evaluated and 114 patients were ultimately enrolled in the study. The mean age was 62 ± 14 years and nearly 40% had metastasis. Ten patients developed VTE recurrence within 6 months (8.8%, 95% confidence interval [CI]: 4.3-15.5%). The DD and hs-CRP levels after 21 days were associated with VTE recurrence. The subdistribution hazard ratios were 9.82 for hs-CRP (95% CI: 19-52) and 5.81 for DD (95% CI: 1.1-31.7).

CONCLUSIONS:

This study identified that hs-CRP and DD were potential biomarkers of VTE recurrence after discontinuation of anticoagulation in CAT. A risk-adapted strategy could identify low-risk patients who may benefit from discontinuation of anticoagulation.

PMID: 30318508 DOI: 10.1038/s41416-018-0269-5

[erjlg3]

You are such an important person in this group Patrick!! You do so much research for yourself and freely share to help everyone!

I would have never known this... I'm not even sure I'll remember it but i'm sure it will help others. You're amazing! Thank you!

🌼Jackie

[erjlg3 in reply to erjlg3]

I do soooo hope that each and every one of you know how important each of you are to our group. It may just be your story that may help someone or your liking their words or their research........ even more, who are always there for any of us...... may even be just your compassion for someone else....etc. Thank you all!

Most sincere,

🌼Jackie

[j-o-h-n in reply to erjlg3]

Ahhh don't mention it.... on second thought.... MENTION IT.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/27/2018 1:17 AM EDT

[erjlg3 in reply to j-o-h-n]

You're a helpful and funny addition John lol. You make us laugh, smile .....and chuckle..... out loud some times too.

🌼Jackie

[wifeofvet]

3 months before my husband passed from his PCa, I woke up from a nap clutching my chest. i dialed 911 immediately. i had 6 pulmonary emboli and 17 DVTs in my left leg. of all the medicine i had studied to keep my husband alive those 13 years, i had never heard of APS...antiphospholipidosis. Well, the first sign is a DVT...and two series of blood tests 12 weeks apart proved i had it. it's just as common in women as in men. the body produces antibodies to two proteins in the blood that KEEP IT from clotting, causing clots. Not many doctors are aware of ''sticky blood'' syndrome, i have come to find out...mostly, just hematologists and rheumatologists. i don't know how common DVTs are in PCa patients, but i would certainly insist on tests for this autoimmunity before i settled on the six-month coumadin regimen..as APS requires lifelong blood thinners.

[Ldtyson]

I was just hospitalized with a pulmonary embolism in lungs and DVT in lower left leg. Doctor told me I was a high risk for clots either from the cancer, cancer drugs or both. They don't seem to know. Either way I'm on Lovenox injections twice a day for life. Another great byproduct of PCa.

[j-o-h-n in reply to Ldtyson]

lovenox? sounds like it would go good with bagels and cream cheese.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/27/2018 10:34 PM EDT

[pjoshea13 in reply to Ldtyson]

This is the problem IMO. No-one cares that we have increased risk because there is no safe drug to prevent clots. They wait until a clot happens before treating. Too bad that many with clots in the lungs never make it to the ER.

Those of us who use nattokinase believe it to be safe & effective.

& the D-dimer test is a great way to keep an eye on things.

-Patrick

[erjlg3 in reply to pjoshea13]

Is this something one should consider only if you've been told that you need blood thinners the rest of your life? Or prevention.... if you have cancer?

Thank you.

🌼Jackie

[pjoshea13 in reply to erjlg3]

Jackie,

I contend that a trip to the ER is not a good way to find out one has a clot.

Cancer increases the risk for a clot, but men with PCa also have a risk for a clot before PCa is diagnosed. There are papers that recommend screening for cancer when a clot occurs.

My feeling is that newly diagnosed men should monitor D-dimer at least annually - probably more frequently.

But it might be an idea for healthy men above age 65 to do the same.

If nattokinase were a drug, this would already be happening, but doctors only have drugs that are considered to be too dangerous for clot prevention. (According to my GP.)

Best, -Patrick

[erjlg3 in reply to pjoshea13]

Thank you so much Patrick

Always wish the best for you and yours

🌼Jackie

[Advo__cate]

What brand of natto do you take? Our M.D. has suggested my husband taking it but she didn’t offer a brand or how much to take.

Do we ask the M.O. for a D-dimer test or G.P.?

[pjoshea13 in reply to Advo__cate]

I used to use Nattozyme because it worked for me when I switched from Warfarin years ago (& still had one blocked vein in my leg.) About 6 months ago I switched to Doctor' Best because I could no longer get a steep discount on Nattozyme. My D-dimer is still at zero.

swansonvitamins.com/?Source...

swansonvitamins.com/q?kw=na...

If I am going to a doctor for something else, I might ask for a D-dimer test. My G.P. is most familiar with my use of it.

But often, it's easier for me to use a Life Extension (LabCorp) test:

lifeextension.com/Vitamins-...

It's much cheaper to buy tests during the annual sale, but that is 3+ months away. I order by phone & get a requisition form emailed to me. I have a LabCorp office nearby. LEF sends me the result by email. Sometimes I get a result within 24 hours of ordering the test.

Req forms never expire. However, LabCorp only keeps them in their system for 6 months. No problem though, since LEF is happy to reissue them.

-Patrick

[jdm3 in reply to pjoshea13]

I get Doctor's Best on Amazon too. Natto-Serra combo.

[Advo__cate in reply to pjoshea13]

Thank you for this information, I appreciate it.

[puxi]

would a Ddimer value of 0.15 microgram /ml be still high? taking nattokwinase and serrapeptase.

[pjoshea13 in reply to puxi]

The LabCorp range is zero to 0.49 mg/L, but their lowest reading is "<20" mg/L. So for me, I have to be content with <20 mg/L.

If I knew that the number was actually 0.15, I wouldn't be concerned, but I would probably take an extra nattokinase at night.

Obviously, one should be very concerned if the result is above the reference range, & perhaps moderately concerned if it is above the halfway mark. But, as with C-reactive protein, I think that lower is always better.

D-dimer can be elevated for reasons other than a clot, but if close to zero, there is no clot.

-Patrick

[puxi]

Do you mean < 0.2mg/L in you case or?

[pjoshea13 in reply to puxi]

Apologies - forgot the decimal point - yes, 0.20 mg/L.

& incidentally, for anyone who is wondering, "microgram /ml" = mg/L.

-Patrick

[Rkoma]

Hi Patrick,

how often do we need to test. What is an appropriate interval?

What is your experience on it?

best regards

Rkoma

[pjoshea13 in reply to Rkoma]

It depends on the latest D-dimer result.

LabCorp doesn't go below 0.20 mg/L & gives the reference range as 0.00-0.49 mg/L.

With a value above 0.49 I would immediately increase nattokinase intake & retest in a month.

With a value of <0.20 mg/L, I might retest in 6 months to a year, depending on how consistent my results have been.

With numbers in between, some tweaking is required, but I'd be inclined to retest in 3 months. No need to panic.

I once reduced my nattokinase & the number jumped from <20 to 20 (LOL), so I increased nattokinase by one cap & I have been <20 ever since.

Best, -Patrick