Deep vein thrombosis (MostPhotos.com)
Difficulties in performing compression ultrasound for diagnosing DVT in the acute situation can result in a delayed or missed diagnosis, with consequences for the individual patient. D-dimer is used to rule out VTE in low-risk patients, while in medium to high-risk patients, diagnostic imaging is necessary to confirm or rule out the diagnosis. In patients with clinical suspicion of DVT referred to compression ultrasound examination (Wells score >2 and/or positive D-dimer), only 15-20% are confirmed to have a DVT. Thus, identification of novel biomarkers with better specificity for acute DVT than D-dimer could improve the diagnostic workup in the acute setting. In this project, we will include patients referred to Akershus University Hospital (Ahus) with suspected DVT, in whom the diagnosis is either confirmed or ruled out by compression ultrasound. We will investigate whether complement components, extracellular vesicles or other circulating biomarkers in blood are increased in those with a confirmed DVT compared with those in whom DVT was ruled out. We will also explore changes in complement components and plasma EVs for up to 1 year after the VTE.
Diagnostic biomarkers of pulmonary embolism
Pulmonary embolism (MostPhotos.com)
Although the symptoms and signs of acute pulmonary embolism (PE) appear rather specific, the diagnosis remains a clinical challenge. Currently, the diagnosis relies on imaging procedures, which are not always possible to perform in acute situations, are resource demanding, and expose the patient to radiation. All together this can result in a delayed or missed diagnosis, as well as increased cancer risk secondary to exposure of radiation. Only 10% of patients examined for suspected PE with CTPA have the diagnosis confirmed. In Norway, approximately 4000 patients are diagnosed with PE annually, implying that approximately 40 000 undergo “unnecessary” CTPA each year. The overall aim of this project is to identify novel and specific biomarkers for acute PE. We will apply a complex strategy by (i) conducting a systematic review to identify current knowledge gaps, (ii) an untargeted proteome analysis of plasma from a standardized PE model in pigs to identify candidate protein markers of PE, and (iii) collect plasma samples from patients referred to three Norwegian hospitals with suspicion of PE in order to identify plasma biomarkers with discriminatory power to distinguish patients with and without PE with high accuracy.
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