D-dimer & Dangerous Blood Clots - Advanced Prostate...

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D-dimer & Dangerous Blood Clots

pjoshea13 profile image
23 Replies

I have posted quite a lot about the importance of D-dimer in the past 5+ years, but the recent post from 5_plus_4, "I almost died Tuesday" had me thinking that perhaps some basic information on coagulation issues needs to be reposted periodically, particularly for new members. No-one should die, or almost die, because of an avoidable blood clot.

The first thing to note is that doctors know that cancer increases the risk of an embolism. They do not monitor patients (via D-dimer) or even warn patients of increased risk, but they do know how to treat patients after a venous thromboembolism (VTE) event. Such treatments are considered too dangerous to use prophylactically - hence the silence.

D-dimer - Wikipedia [1]:

"D-dimer ... is a fibrin degradation product .., a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis.

"D-dimer concentration may be determined by a blood test to help diagnose thrombosis. Since its introduction in the 1990s, it has become an important test performed in people with suspected thrombotic disorders, such as venous thromboembolism. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis, but does not exclude other potential causes. Its main use, therefore, is to exclude thromboembolic disease where the probability is low."

Studies.

A study from Austria [2a], (published before many here were diagnosed,) tells the story:

"In a prospective, observational, cohort study of 821 patients with newly diagnosed cancer or progression of disease who did not recently receive chemotherapy, radiotherapy, or surgery were enrolled and followed for a median of 501 days".

There were 101 PCa cases.

"VTE occurred in 62 patients (7.6%)." i.e. 62 of 821 - they don't report by cancer type

"Interestingly, a systematic activation of coagulation is observed in patients with cancer, and this activation leads to augmented thrombin generation followed by fibrin formation. It has been suggested that fibrin may contribute to tumor growth and to processes that lead to tumor invasion and metastasization by promoting angiogenesis and formation of a protective fibrin shield on malignant tumor cells, which makes tumor cells resistant to endogenous defense mechanisms."

This last sentence is particularly important, since control of fibrin may dramatically reduce or limit metastasis.

"High D-dimer levels were associated with VTE in a population-based cohort study, and prospective studies have shown that D-dimer levels are predictive of recurrence in patients without cancer."

"There was no routine screening for VTE. Objective imaging methods were performed to confirm or exclude the diagnosis only when a patient developed symptoms of VTE."

... the usual benign neglect ...

"{pulmonary embolism} was fatal in four patients (6.4% of VTE events)."

"Overall, the cumulative probabilities of VTE in the total study population were 5.7% after 6 months and 7.9% after 1 year."

More from Vienna [2b]:

High D-dimer levels are associated with poor prognosis in cancer patients

***

Thrombosis due to cancer is sometimes detected before the cancer:

[3] A case of cerebral venous thrombosis as the presenting sign of occult prostate cancer

& elevated D-dimer alone may occur before cancer diagnosis:

[4] Elevated D-dimers are also a marker of underlying malignancy and increased mortality in the absence of venous thromboembolism

so altered coagulation is an early event in PCa.

Plasmin - Wikipedia [5]:

"Plasmin is an important enzyme ... present in blood that degrades many blood plasma proteins, including fibrin clots. The degradation of fibrin is termed fibrinolysis."

While plasmin will eventually clear a clot that is not growing, it is not up to dealing with a chronically active clot.

Nattokinase - Wikipedia [6]:

"Nattokinase ... is an enzyme extracted and purified from a Japanese food called nattō. Nattō is produced by fermentation by adding the bacterium Bacillus natto, which also produces the enzyme, to boiled soybeans. While other soy foods contain enzymes, it is only the nattō preparation that contains the specific nattokinase enzyme.

"When in contact with human blood or blood clots, it exhibits a strong fibrinolytic activity."

[7] A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles

"D-dimer concentrations at 6, and 8 hours, and blood fibrin/fibrinogen degradation products at 4 hours after NK administration elevated significantly"

[8] Nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII in human subjects

Healthy men have a certain level of fibrinogen in circulation in case that sudden bleeding requires fibrin to plug the leak. In PCa, inflammation sends the level of fibrinogen much higher than it should be. Nattokinase can counter that.

***

I periodically get a D-dimer test. There is a reference range, but I have zero tolerance. I want to keep the number as close to zero as possible.

The standard nattokinase dose is 2,000 FUs (fibrinolytic units), but that is unlikely to be sufficient for anyone with cancer. The D-dimer test is essential IMO.

-Patrick

[1] en.wikipedia.org/wiki/D-dimer

[2a] ascopubs.org/doi/10.1200/JC...

[2b] ncbi.nlm.nih.gov/pmc/articl...

[3] pubmed.ncbi.nlm.nih.gov/200...

[4] pubmed.ncbi.nlm.nih.gov/206...

[5] en.wikipedia.org/wiki/Plasmin

[6] en.wikipedia.org/wiki/Natto...

[7] pubmed.ncbi.nlm.nih.gov/261...

[8] pubmed.ncbi.nlm.nih.gov/193...

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23 Replies
cigafred profile image
cigafred

Such a nice summary--there should be some way to post it so that all newcomers to this site have a chance to read it.

noahware profile image
noahware

Thank you for the review!

Seems to make sense to push our diets towards more foods that have anti-inflammatory and/or anti-angiogenic properties?

Daveofnj profile image
Daveofnj

I had a clot in my leg before being diagnosed with PCa. A blood test ordered by the Hematologist was positive for Lupus Anticoagulant factor. The Hematologist put me on Xarelto and six months later repeated the same test, which was negative for the Lupus Anticoagulant. The Hematologist said it's not uncommon for such tests to be positive then negative then positive and the reason is not understood.

I've been taking low dose Xarelto (10mg) and Nattokinase for four years now.

lcfcpolo profile image
lcfcpolo

Great and very valuable summary. I agree with cigafred that all newly diagnosed men need to see this. Like Daveofnj I had a DVT, 2 infact before diagnosis. Does anyone know if you can take nattokinase when already taking Apixaban (Eliquis)?

LearnAll profile image
LearnAll

Thanks Patrick. This post was really timely and needed. Yes..no body needs to "die nearly" due to clot formation.. Agree. It is totally preventable by blood thinning food items (Garlic, Ginger, Onions, Turmeric) and Of Course by Nattokinase. This is why we need to empower ourselves with knowledge and not blindly depend on our Doctors. I take 4000 FU of Nattokinase a day.

Purple-Bike profile image
Purple-Bike in reply to LearnAll

LearnAll, what do you take your Turmeric with? Poor absorption is supposed to be helped by piperine or fats like phospholids, but both get a bad rap in this article mygenefood.com/blog/curcumi... which claims a water soluble formula (polyvinylpyrrolidone) has better absorption without the side effects of piperine and phospholids.

LearnAll profile image
LearnAll in reply to Purple-Bike

When Turmeric is part of regular diet and eaten in almost every dish 3 times a day...there is sufficient absorption specially if some Black pepper is used with it. Bioavailability issue is mostly in people who take Curcumin in small dose as a drug/supplement.Over at least one billion people in the World eat Turmeric powder as part of their daily diet and we never hear any problems it has caused. I would rather take Natural, preferably organically (home grown) Turmeric than any of the synthetic compound.

pjoshea13 profile image
pjoshea13 in reply to LearnAll

I once watched the British chef Gordon Ramsay make his idea of an Indian dish. When it came time to add spices, he used an alarming amount of turmeric. I know from my Indian cookbooks that only small amounts are added to a dish. And I have seen a warning that too much will make the meal bitter. I never saw rhe point of turmeric as a flavoring & assumed it was added perhaps for digestive reasons. It has been a part of Ayurvedic medicine for 4,000 years.

In any case, given that only 3% of turmeric is curcumin, it would take more than 3 Indian meals to satisfy by curcumin needs.

-Patrick

Here is an online recipe - the first one that came up - 1/4 teaspoon turmeric for 4 servings!!!

yummly.com/recipe/Chicken-C...

GreenStreet profile image
GreenStreet

Thanks Patrick. Much to my frustration I can’t get anyone in the UK to give me a D Dimer test (neither my GP nor Oncologist). I am therefore flying blind but I have been taking 6000 FU of Natto 4 days a week and 8000 FU 3 days a week which I hope will be about right. Although I gather it works differently I also take 75mg enteric coated aspirin 5 days a week.

edgeh profile image
edgeh in reply to GreenStreet

I read on general info re: natto, that combined with aspirin, it can lead to stroke. Maybe check it out.

GreenStreet profile image
GreenStreet in reply to edgeh

Thanks. Can you source where you read that?

pjoshea13 profile image
pjoshea13 in reply to GreenStreet

As I recall, the anecdotal case had already suffered a stroke. The aspirin contributed to a bleeding issue. A high dose of nattokinase effectively prevented clots forming at the bleeding sites. This presumably caused a hemorrhagic stroke - not ischemic.

Some people should not be using aspirin - even low-dose. Decades ago now, the fathers of my boss & his boss ended up in the ER (not together), when they noticed blood in their toilet bowls. They were bleeding from the stomach..

Countless men take daily aspirin even though it has been shown only to be useful for those who have had a cardio event. A small percentage of those are presumably occult bleeders and perhaps should be careful of nattokinase. But, as I keep saying, the guide for using nattokinase, and at what dose, is the D-dimer test.

-Patrick

edgeh profile image
edgeh in reply to pjoshea13

Thank you for the reply. The D-dimer Test appears to be the starting point before beginning natto.

Alinur profile image
Alinur

ThanKs all.How high D-DIMER is to be dangerous? Mine is 0.38.

pjoshea13 profile image
pjoshea13 in reply to Alinur

LabCorp defines "normal" as <0.5 mg/L FEU.

The lowest result they report is <0.2, which is what I aim for. While <0.5 may give some assurance that an ER trip is not imminent, it does not exclude the possibility of micro-clots that could help the spread of the cancer.

Here is the LabCorp blurb:

"According to the assay manufacturer's published package insert, a

normal (<0.50 mg/L FEU) D-dimer result in conjunction with a non-high clinical probability assessment, excludes deep vein thrombosis (DVT)

and pulmonary embolism (PE) with high sensitivity.

.

D-dimer values increase with age and this can make VTE exclusion of

an older population difficult. To address this, the American College

of Physicians, based on best available evidence and recent guidelines,

recommends that clinicians use age-adjusted D-dimer thresholds in

patients greater than 50 years of age with: a) a low probability of

PE who do not meet all Pulmonary Embolism Rule Out Criteria, or

b) in those with intermediate probability of PE. The formula for an

age-adjusted D-dimer cut-off is "age/100". For example, a 60 year old

patient would have an age-adjusted cut-off of 0.60 mg/L FEU and an

80 year old 0.80 mg/L FEU."

... but at age 73, I can keep D-dimer <0.2, so that's what I do.

Your 0.38 result excludes an embolism - if you are free of symptoms - but does not exclude micro-clots that might protect circulating cancer cells.

-Patrick

keepinon profile image
keepinon in reply to pjoshea13

I am on a blood thinner for mild A-Fib. Pradaxa. Should I still be worried about D-dimmer levels and taking Natto? Many thanks!

pjoshea13 profile image
pjoshea13 in reply to keepinon

Pradaxa [Dabigatran] is an anticoagulant, so will prevent serious blood clots, at the appropriate dose. I suppose you are on 2 x 150 mg?

Will that guarantee the absence of microclots? I don't know. I would think that plasmin would naturally take care of any that occur.

In the PETRO study (2007) [1]:

"Thromboembolic events were limited to the 50-mg dabigatran dose groups (2 of 107, 2%)." So the dose is important.

"The mean trough d-dimer measurements were suppressed for the 2 highest doses of dabigatran". Don't ask me what that means, but it sounds good.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/179...

keepinon profile image
keepinon in reply to pjoshea13

Dang. I was going to ask you what that meant! Thank you for your knowledge! And willingness to share.

Spyder54 profile image
Spyder54

Think most of us needed that refresher. Gratzee’

Talk about benign neglect. My urologist and primary care doctor have never suggested a D-dimer test.I might have to wave this post in front of them as part of their continuing education. 😬 I also realized that my K2/nattokinase supplement provides far less than even 2000 FU of natto.

edgeh profile image
edgeh

Is it safe to also take 75mg aspirin with natto? There is evidence of strokes associated with taking both.

edgeh profile image
edgeh

Thank you, l look forward to celebrating your 100th birthday. If anyone gets there, it will be you.

edgeh profile image
edgeh

Ah, good strategy. I realised afterwards, if you did become a centurion l would be beyond that. So sorry, l won't be there to sing.

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