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Relationship between plasma (D)-dimer level and cerebral infarction volume in patients with nonvalvular atrial
Mari Matsumoto1, Manabu Sakaguchi, Shuhei Okazaki
1Stroke Center, Osaka University Graduate School of Medicine, Osaka, Japan. m-marine@medone.med.osaka-u.ac.jp
Insights
Plasma D-dimer levels on admission correlate with stroke severity in nonvalvular atrial fibrillation (NVAF) patients. Higher D-dimer levels indicate larger infarct size and poorer functional outcomes after cardioembolic stroke.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- Plasma D-dimer may indicate thrombus activity in nonvalvular atrial fibrillation (NVAF).
- Warfarin anticoagulation reduces stroke and D-dimer levels in NVAF patients.
- The predictive value of D-dimer for stroke severity is not well-established.
Purpose of the Study:
- To investigate the association between plasma D-dimer levels at admission and infarct size in NVAF patients.
- To assess the influence of D-dimer levels on functional outcomes in NVAF patients.
Main Methods:
- 124 NVAF patients with ischemic stroke were analyzed.
- Infarction volume was measured by CT scan.
- Plasma D-dimer levels, cardiovascular risk factors, and admission conditions were assessed.
Main Results:
- Infarction volume correlated with D-dimer levels, blood pressure, NIHSS score, and mRS score.
- D-dimer levels remained significantly associated with infarction volume after multivariate analysis.
- Higher D-dimer tertiles were linked to worse functional outcomes.
Conclusions:
- Plasma D-dimer levels on admission are significantly related to infarct size in NVAF patients.
- D-dimer levels predict functional outcomes following cardioembolic stroke in NVAF patients.
Background:
Plasma D-dimer level may reflect the activity of thrombus formation in the left atrium of patients with nonvalvular atrial fibrillation (NVAF). Proper anticoagulation with warfarin dramatically decreases the rate of cerebral embolism, reduces stroke severity and subsequent risk of death, as well as the level of D-dimer in NVAF patients. However, the predictive value of D-dimer level on cerebral embolism severity has not been examined. Thus, the purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in NVAF patients.
Methods:
We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 h of symptom onset. We measured infarction volume from CT taken after 3 ± 1 days from the onset. Plasma D-dimer levels were measured at the time of admission. Relationships were analyzed between infarction volume and plasma D-dimer levels, cardiovascular risk factors, preadmission medications and admission conditions. We also assessed the influence of D-dimer level on functional outcome in patients with preadmission modified Rankin Scale (mRS) score of 0-1 and patients by tertile of D-dimer level (≤0.83, 0.83-2.16 and ≥2.16 µg/ml).
Results:
Infarction volume significantly correlated with D-dimer level (r = 0.309, p < 0.001), systolic blood pressure (r = 0.201, p = 0.026), diastolic blood pressure (r = 0.283, p = 0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r = 0.546, p < 0.001) and mRS score at discharge (r = 0.557, p < 0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume after adjusting for age, sex, current smoker or not, prothrombin time-international normalized ratio ≥1.6, diastolic blood pressure, CHADS(2) score and NIHSS score on admission. In patients with a preadmission mRS score of 0-1 (n = 108), D-dimer level was significantly associated with NIHSS score at admission (r = 0.318, p < 0.001) and mRS score at discharge (r = 0.310, p = 0.001). Patients in the highest D-dimer tertile group showed worse outcome than those in the middle (p = 0.041) and lowest (p < 0.001) tertiles.
Conclusions:
Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.
