The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke

Abstract

Background Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. Aims To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. Summary D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. Conclusion Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.

High Prevalence of Deep Venous Thrombosis in Non-Severe COVID-19 Patients Hospitalized for a Neurovascular Disease

“…DVT patients were older and had a worse admission median NIHSS score than non-DVT patients (77 years old [71-85] vs. 69.5 years old , and 14 [IQR, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] vs. 3 [IQR, 0-15], respectively).…”

“…Considering that the coagulation activation markers are often disturbed in neurovascular diseases, we did not use biological screening. This non-invasive procedure may be more accurate to detect DVT than the use of D-dimer levels, which is correlated to COVID-19 severity [20], because they are also increased in the acute phase of stroke in absence of COVID-19 [19]. Since it was suggested that DUS should be performed on all patients and integrated into medical care of COVID-19 patients [3, 4], we used systematic bedside DUS.…”

“…Therefore, our research was not designed or intended for biological study and some markers were not investigated. Particularly, we decided to avoid dosage of D-dimer in our clinical practice, considering that its levels are known to be increased in stroke situations [19].…”

Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion

“…In CE stroke, it is hypothesized that D-dimer levels reflect the formation of fibrin-rich thrombus in the left atrium. Contrarily, thrombi originating from large arteries are believed to be mostly plateletrich and therefore only promote a mild D-dimer increase (82). The association of higher levels of D-dimer with CE stroke etiology when measured during the acute phase (<48 h) has been repeatedly shown in individual studies (45)(46)(47)(48)(49)(50).…”

D-dimer in ischemic stroke, and insights from HEADPOST into swallowing problems and outcome after stroke

“…Fortunately, this was benign and since the tumor's excision, Ddimer has fallen and she has remained symptom free. The potential utility of D-dimer in stroke care is reviewed in this journal by Ohara et al 1 They describe how D-dimer may be elevated in certain subtypes of stroke, for example cardioembolic versus lacunar stroke, but sensibly point out that other diagnostic methods, such as brain imaging, mean that its contribution here is limited. However, they highlight its particular use in detecting occult cancer.…”