Evaluation of Plasma d-Dimer Plus Fibrinogen in Predicting Acute CVST

Abstract

Background Prompt diagnosis of cerebral venous sinus thrombosis is a challenge owing in part to its complex and nonspecific early clinical symptoms. Objective This study aims to evaluate the value of clinically useful biomarkers (D-dimer and fibrinogen) for cerebral venous sinus thrombosis prediction. Methods Two-hundred and thirty-three suspected cerebral venous sinus thrombosis patients were enrolled in this prospective study. Thirty-four cases confirmed as cerebral venous sinus thrombosis using imaging modalities, whereas the other 199 cases served as mimic controls. Plasma samples of 34 healthy controls were further collected from age- and gendermatched volunteers. D-dimer and fibrinogen levels of all patients and controls were measured before imaging and treatment. The dynamic D-dimer and fibrinogen levels in cerebral venous sinus thrombosis cases after anticoagulation were monitored for up to 180 consecutive days. Results At admission before treatment the average D-dimer and fibrinogen levels in cerebral venous sinus thrombosis group were 968·9 ± 160·1 mg/l and 6·9 ± 1·3 g/l, both of which were significantly elevated when compared with that of the controls. In cerebral venous sinus thrombosis patients, 94·1% had D-dimer elevation, 73·5% had fibrinogen elevation, and 67·6% had both elevated D-dimer and fibrinogen. During acute phase, the sensitivity and specificity of predicting cerebral venous sinus thrombosis using only D-dimer were 94·1% and 97·5%, whereas that of D-dimer in combination with fibrinogen were 67·6% and 98·9%. After administering anticoagulation, D-dimer levels gradually recovered; however, fibrinogen levels fluctuated with 33·3% of the patients still exhibiting elevated values up until 180 days. Conclusions D-dimer may serve as an important screening tool to determine the urgency of obtaining magnetic resonance imaging/magnetic resonance venography or digital subtraction angiography in patients presenting with clinical symptoms that are suspected of cerebral venous sinus thrombosis. Furthermore, D-dimer in combination with fibrinogen may increase the predictive value of acute cerebral venous sinus thrombosis.

Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium

“…In the current study, multivariate logistic analysis revealed that D-dimer levels >1134µg/L and impaired consciousness were independent risk factors of poor outcome. D-dimer, a degration product of cross-linked fibrin, is a hypercoagulability marker and could be used in predicting CVST [19,20]. A high D-dimer level is correlated with greater thrombosis extension and severity of CVST [21].…”

Extracranial and intracranial arterial stenoocclusive disease in acute ischemic stroke patients: A study from north India - Evaluation with MR angiography

“…In their study, Meng R et al had 2.5% false positive in mimic group and no false positive subject in healthy control group while 5.9% patients had false negative D-dimer values. (4) Because there is a correlation between limited sinus involvement and a negative D-dimer assay, it is tempting to speculate that the most important factor is the extension of thrombosis. In DVT, D-dimer levels are significantly higher in patients with proximal thrombosis than in those with thrombosis below the knee, (20) and they are correlated with clot volume and surface as shown using thrombus MRI.…”

“…Different studies have shown varied results regarding utility of Ddimer in CVT. (4,5,6,7) Most of the previous studies are based on selected patient populations including patients with isolated headache. (6,7) This study was done to evaluate patients who were diagnosed CVT having diverse clinical manifestations and assess the importance of D-dimer in the diagnosis.…”

A retrospective analysis of cerebral venous sinus thrombosis-a series of 25 cases

“…Since literatures reported the application of D2 dimer to evaluate the risk of CVST [10][11][12] , all of our cases had D2 dimer examination. Results revealed that 60% of the cases had increased D2 dimer while 40% were normal.…”