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D-dimers are not always elevated in patients with acute aortic dissection
Domenico Paparella1, Pietro Giorgio Malvindi, Giuseppe Scrascia
1Division of Cardiac Surgery, Department of Emergency and Organ Transplant (D.E.T.O.), University of Bari, Bari, Italy. dpaparella@cardiochir.uniba.it
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|April 21, 2009
Summary
D-dimer tests are not always elevated in acute aortic dissection cases. This finding cautions against relying solely on D-dimers to rule out this life-threatening condition, potentially delaying critical treatment.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Laboratory Medicine
Background:
- Early diagnosis of acute aortic dissection (AAD) is crucial for patient outcomes, preventing complications like rupture and cardiac tamponade.
- Currently, no definitive blood marker can reliably exclude AAD.
- D-dimer testing has been proposed as a negative predictive tool for AAD in patients with chest pain.
Purpose of the Study:
- To evaluate the utility of preoperative D-dimer levels in patients with confirmed acute aortic dissection.
- To assess the correlation between D-dimer levels, time from symptom onset, and dissection extent.
Main Methods:
- Retrospective analysis of 61 patients with confirmed acute aortic dissection.
- Assay of preoperative D-dimer levels, with abnormal values defined as >400 microg/L.
- Correlation analysis with time from symptom onset and De Bakey classification.
Main Results:
- D-dimer levels were elevated (>400 microg/L) in 82% (50/61) of patients.
- 18% (11/61) of patients had D-dimer levels below 400 microg/L.
- No significant correlation was found between D-dimer levels and time from symptom onset (r = -0.232; P = 0.1).
Conclusions:
- D-dimer levels are not consistently elevated in all patients with acute aortic dissection.
- The negative predictive value of D-dimer testing for AAD may be limited.
- Caution is advised when using D-dimer tests to rule out AAD, as a negative result could lead to diagnostic delays and adverse outcomes.
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