Background: Different coagulation abnormalities according to stroke subtypes have been reported. We have assessed the clinical utility of D-dimer, a product of fibrin degradation, in the early diagnosis of stroke subtypes. Methods: Patients hospitalized after an acute ischemic cerebrovascular event underwent D-dimer assay (STA Liatest D-Dimer) (reference level, <0.50 μg/mL) on days 1, 6 ± 1, and 12 ± 1 and were studied to identify stroke subtypes. Results: We included 126 patients (mean age, 75.5 years) and 63 age-matched control subjects. Stroke subtypes were cardioembolic in 34 patients (27%), atherothrombotic in 34 (27%), lacunar in 31 (25%), and unknown in 27 (21%). At all 3 measurements, D-dimer levels were significantly higher in the cardioembolic group (mean ± SEM, 2.96±0.51, 2.58±0.40, and 3.79±0.30 μg/mL, respectively) than in the atherothrombotic (1.34±0.21, 1.53±0.26, and 2.91±0.23 μg/mL, respectively) (P<.05) and lacunar (0.67±0.08, 0.72±0.15, and 0.64±0.06 μg/mL, respectively) groups (P<.01). The difference was also significant between the latter 2 groups (P<.01). We found no difference between the lacunar group and controls (0.53 ± 0.14 μg/mL). According to day 1 measurements, the optimal cutoff point for predicting cardioembolic stroke was 2.00 μg/mL, resulting in a specificity of 93.2% and in a sensitivity of 59.3%. For predicting lacunar stroke, the cutoff point was 0.54 μg/mL, with a specificity of 96.2% and a sensitivity of 61.3%. Conclusion: The increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with acute cerebrovascular ischemic events to help predict stroke subtype.
Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes / W. Ageno, S. Finazzi, L. Steidl, M. G. Biotti, V. Mera, G. Melzi D'Eril, A. Venco. - In: ARCHIVES OF INTERNAL MEDICINE. - ISSN 0003-9926. - 162:22(2002 Dec), pp. 2589-2593.
Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes
W. Ageno;
S. Finazzi;
L. Steidl;
M. G. Biotti;
V. Mera;
G. Melzi D'Eril
Penultimo
;
A. Venco
2002
Abstract
Background: Different coagulation abnormalities according to stroke subtypes have been reported. We have assessed the clinical utility of D-dimer, a product of fibrin degradation, in the early diagnosis of stroke subtypes. Methods: Patients hospitalized after an acute ischemic cerebrovascular event underwent D-dimer assay (STA Liatest D-Dimer) (reference level,
<0.50 μg/ml)="" on="" days="" 1,="" 6="" ±="" 1,="" and="" 12="" ±="" 1="" and="" were="" studied="" to="" identify="" stroke="" subtypes.="" results:="" we="" included="" 126="" patients="" (mean="" age,="" 75.5="" years)="" and="" 63="" age-matched="" control="" subjects.="" stroke="" subtypes="" were="" cardioembolic="" in="" 34="" patients="" (27%),="" atherothrombotic="" in="" 34="" (27%),="" lacunar="" in="" 31="" (25%),="" and="" unknown="" in="" 27="" (21%).="" at="" all="" 3="" measurements,="" d-dimer="" levels="" were="" significantly="" higher="" in="" the="" cardioembolic="" group="" (mean="" ±="" sem,="" 2.96±0.51,="" 2.58±0.40,="" and="" 3.79±0.30="" μg/ml,="" respectively)="" than="" in="" the="" atherothrombotic="" (1.34±0.21,="" 1.53±0.26,="" and="" 2.91±0.23="" μg/ml,="" respectively)=""><.05) and="" lacunar="" (0.67±0.08,="" 0.72±0.15,="" and="" 0.64±0.06="" μg/ml,="" respectively)="" groups=""><.01). the="" difference="" was="" also="" significant="" between="" the="" latter="" 2="" groups=""><.01). we="" found="" no="" difference="" between="" the="" lacunar="" group="" and="" controls="" (0.53="" ±="" 0.14="" μg/ml).="" according="" to="" day="" 1="" measurements,="" the="" optimal="" cutoff="" point="" for="" predicting="" cardioembolic="" stroke="" was="" 2.00="" μg/ml,="" resulting="" in="" a="" specificity="" of="" 93.2%="" and="" in="" a="" sensitivity="" of="" 59.3%.="" for="" predicting="" lacunar="" stroke,="" the="" cutoff="" point="" was="" 0.54="" μg/ml,="" with="" a="" specificity="" of="" 96.2%="" and="" a="" sensitivity="" of="" 61.3%.="" conclusion:="" the="" increasing="" use="" of="" the="" d-dimer="" assay="" in="" clinical="" practice="" could="" be="" extended="" to="" patients="" presenting="" with="" acute="" cerebrovascular="" ischemic="" events="" to="" help="" predict="" stroke="" subtype.="">
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