D-dimer levels remain elevated in acute aortic dissection after 24 h.

Area of Science:

• Cardiovascular Medicine
• Hematology
• Diagnostic Biomarkers

Background:

• Elevated D-dimer levels are characteristic of acute aortic dissection (AAD).
• Current guidelines use D-dimer to exclude AAD within 24 hours of symptom onset.
• The utility of D-dimer for ruling out AAD beyond 24 hours, within the acute phase, remains under investigation.

Purpose of the Study:

• To test the hypothesis that D-dimer levels remain elevated in AAD patients for at least 10 days post-dissection onset.
• To evaluate the reliability of D-dimer testing for AAD diagnosis in the subacute phase (24 hours to 10 days).

Main Methods:

• D-dimer levels were measured in 100 patients with confirmed AAD using preoperative heparinized plasma samples up to 10 days after symptom onset.
• Serial sampling was performed when feasible for at least 2 days.
• Validation of heparinized versus citrated plasma samples was conducted for D-dimer measurement accuracy using the BCS XP analyzer.

Main Results:

• A high correlation (0.991) was observed between D-dimer levels in heparinized and citrated plasma samples.
• The D-dimer assay demonstrated an overall sensitivity of 95.3% for detecting AAD in patients up to 10 days post-onset at a threshold of 1.6 μg/mL.

Conclusions:

• D-dimer levels remain significantly elevated in AAD patients for up to 10 days after dissection onset.
• D-dimer testing may be a valuable tool for ruling out AAD in patients presenting beyond the initial 24-hour window but still within the acute period.
• Heparinized plasma is a suitable alternative to citrated samples for D-dimer assessment with the BCS XP coagulation analyzer.