Related Experiment Video

Updated: Dec 4, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.2K

D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation

Alexandre Almorad1,2, Anush Ohanyan3, Georgiana Pintea Bentea3

  • 1Cardiology, Brugmann University Hospital, Brussels, Belgium alexandre.almorad@live.com.

Heart (British Cardiac Society)
|October 22, 2020
PubMed

Insights

D-dimer blood tests can safely exclude left atrial thrombus in patients with atrial fibrillation (AF) before cardioversion. Age-adjusted D-dimer cut-offs increase the number of patients who can avoid transoesophageal echocardiography.

Area of Science:

  • Cardiology
  • Diagnostic Medicine
  • Biochemistry

Background:

  • Left atrial (LA) thrombus is a risk factor for stroke in patients with non-valvular atrial fibrillation (AF).
  • Transoesophageal echocardiography (TOE) is the standard method for excluding LA thrombus before cardioversion.
  • There is a need for non-invasive methods to identify patients who do not require TOE.

Purpose of the Study:

  • To evaluate the efficacy of two D-dimer cut-offs for excluding LA thrombus in patients with AF.
  • To compare a fixed D-dimer cut-off (DD500) with an age-adjusted cut-off (DDAge).
  • To determine if D-dimer testing can safely reduce the need for precardioversion TOE.

Main Methods:

  • Prospective enrollment of 142 consecutive patients with non-valvular AF undergoing precardioversion TOE.
  • Measurement of D-dimer concentrations using an ELISA test at the time of TOE.
  • Comparison of DD500 (500 ng/mL) and DDAge (age x 10 ng/mL) cut-offs for LA thrombus exclusion.

Main Results:

  • LA thrombus was excluded by TOE in 91% of patients.
  • D-dimer levels were significantly lower in patients without LA thrombus (729 vs 2376 ng/L).
  • The age-adjusted DDAge cut-off demonstrated higher specificity (66.4%) than DD500 (50.4%) for excluding LA thrombus. Both cut-offs had 0% false negatives.
  • 60.6% of patients with D-dimers below the DDAge threshold and no LA thrombus could have potentially avoided TOE.

Conclusions:

  • D-dimer testing is effective in excluding LA thrombus in AF patients.
  • Age-adjusted D-dimer cut-offs significantly improve the ability to safely exclude LA thrombus.
  • This approach can reduce the number of patients requiring precardioversion transoesophageal echocardiography.
Abstract

Keywords:
atrial fibrillationechocardiographystroke

More Related Videos

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation08:10

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Published on: July 20, 2022

2.0K
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.7K

Related Concept Videos

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
163
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.7K
Dysrhythmias V: Evaluating Dysrhythmias01:30

Dysrhythmias V: Evaluating Dysrhythmias

Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
224
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
165
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.3K
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
283