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D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study
Gottfried Sodeck1, Hans Domanovits, Martin Schillinger
1Department of Emergency Medicine, Medical University Vienna, Vienna, Austria.
European Heart Journal
|November 8, 2007
Summary
Blood D-dimer testing is a sensitive marker for excluding acute aortic dissection (AAD). A D-dimer level below 0.1 microg/mL effectively rules out AAD in all cases.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Biomarker Research
Background:
- Acute aortic dissection (AAD) is a life-threatening condition requiring rapid diagnosis.
- Blood D-dimer testing is a sensitive biomarker, but its utility in excluding AAD needs validation.
- Previous studies suggest D-dimer's potential for ruling out AAD.
Purpose of the Study:
- To systematically review existing evidence on D-dimer testing for AAD exclusion.
- To validate the diagnostic performance of D-dimer testing in a prospective patient cohort.
- To determine optimal D-dimer cut-off levels for excluding AAD.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, CINAHL, and BIOSIS up to January 2007.
- Abstraction of study characteristics, assay types, cut-off levels, and diagnostic performance metrics (sensitivity, specificity).
- Prospective validation in a cohort of 65 patients with confirmed AAD.
Main Results:
- 16 studies (437 patients) reported D-dimer cut-off values from 0.1 to 0.9 microg/mL.
- Pooled sensitivity for D-dimer testing was high (0.97), with a low negative likelihood ratio (0.06).
- In the prospective cohort, D-dimer levels varied widely; a cut-off of 0.1 microg/mL yielded 100% negative predictive value.
Conclusions:
- Evidence supports routine D-dimer measurement for excluding AAD.
- A D-dimer level below 0.1 microg/mL can reliably exclude AAD.
- D-dimer testing offers a valuable tool for ruling out acute aortic dissection.
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