D-dimer levels remain elevated in acute aortic dissection after 24 h

Albini, Paul T.; Barshes, Neal R.; Russell, Ludivine; Wu, Danli; Coselli, Joseph S.; Shen, Ying H.; Allison, Paul M.; LeMaire, Scott A.

doi:10.1016/j.jss.2014.03.074

Cited by 13 publications

(8 citation statements)

References 28 publications

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“…D‐dimer has a half‐life of ≈8 hours 5. Although the sensitivity of D‐dimer testing remains high at 95.3% up to 10 days after the onset of AAD,34 delayed hospital arrival may influence the D‐dimer concentration, possibly obscuring the telltale elevation.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

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BackgroundClinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified.Methods and ResultsD‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21).ConclusionsD‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

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“…Although there are many examination method available, in view of rapid rescue after the onset, early examination and diagnosis method should be easy to operate, and the results should come out quickly. In view of time consumption or complex operation limitations of the above diagnostic methods, POCT laboratory indexes have been gradually applied to identify and diagnose primary disease of fatal chest pain [4] .…”

Section: Discussionmentioning

confidence: 99%

Discussion on Diagnostic Value of D-dimer and Troponin POCT in Emergency Department for Fatal Chest Pain Caused by Acute Myocardial Infarction and Acute Aortic Dissection

2018

2018 7th International Conference on Medical Engineering and Biotechnology (MEDEB 2018)

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Objective: to summarize and analyze application value of Point Of Care Testing (POCT) of D-dimer and troponin in diagnosis and identification of fatal chest pain caused by acute myocardial infarction and acute aortic dissection. Method: 120 patients with chest pain who were received and treated by the emergency department from June 2015 to May 2018 were chosen as the objects of study. D-dimer and troponin POCT was implemented for all patients. Finally, 58 patients were definitely diagnosed with acute myocardial infarction, and 62 patients were definitely diagnosed with acute aortic dissection. The level of D-dimer and troponin was compared and analyzed for both groups. Results: D-dimer level of patients with acute aortic dissection was higher than that of patients with acute myocardial infarction. Troponin level of patients with acute aortic dissection was lower than that of patients with acute myocardial infarction. The comparison of the above index differences had statistical significance (P<0.05). Conclusion: rapid bedside detection of D-dimer and troponin can effectively identify and diagnose fatal chest pain caused by acute myocardial infarction and acute aortic dissection, provides basis for early rescue and treatment and improve patients' prognosis, so it deserves to be promoted and applied. Acute coronary syndrome, pulmonary embolism, aortic dissection, acute myocardial infarction, cardiac tamponade and tension pneumothorax can cause fatal chest pain. The above diseases are characterized by sudden onset and fast disease changes. Timely rescue and treatment can help patients eliminate symptoms, and standard treatment can make sure patients with different diseases can receive treatment within a short time [1]. The development of POCT allows more acute disease patients to complete diagnosis at bedside and provides basis for

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“…It is important that DD concentrations may be measured in 2 different units: DD unit (DDU) or fibrinogen equivalent unit (FEU). One DDU is equivalent to 2 FEU 44,45 . Therefore, DD units should be reported in publications and different units (DDU or FEU) can not be used interchangeably.…”

Section: Cut-off Values Of Dd For Aodmentioning

confidence: 99%

“…False negative results (when DD is normal in an AoD patient) were most likely in patients: 1) under 70 years old, with intromural hemorrhage (IMH), with thrombosed false lumen, and with shorter dissections (in length) 40,44,46,47 . DD concentration may be within the normal limits in young patients with short dissection and a thrombosed false lumen, without penetrating atherosclerotic ulcer (PAU) 30 .…”

Section: False Negatives Dd In Aodmentioning

confidence: 99%

Biomarkers in aortic dissection, including specific causes of troponin elevation

et al. 2016

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D-dimer levels remain elevated in acute aortic dissection after 24 h

Cited by 13 publications

References 28 publications

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Discussion on Diagnostic Value of D-dimer and Troponin POCT in Emergency Department for Fatal Chest Pain Caused by Acute Myocardial Infarction and Acute Aortic Dissection

Biomarkers in aortic dissection, including specific causes of troponin elevation

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