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D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke
Anna Ramos-Pachón1, Elena López-Cancio2, Alejandro Bustamante1
1Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.).
Insights
Early D-dimer levels can predict large vessel occlusion (LVO) in acute ischemic stroke, improving prehospital triage and speeding up treatment. This helps identify stroke candidates for endovascular therapy.
Area of Science:
- Neurology
- Biomarkers
- Stroke Research
Background:
- Large vessel occlusion (LVO) stroke requires rapid reperfusion therapy.
- Effective prehospital triage is crucial for timely treatment of LVO.
- Identifying early predictors of LVO can optimize patient selection for endovascular treatment.
Purpose of the Study:
- To investigate early predictors of LVO in acute ischemic stroke.
- To identify potential biomarkers for LVO detection.
- To improve prehospital triage and reduce time to reperfusion therapies.
Main Methods:
- Prospective observational study (Stroke-Chip) at 6 stroke centers.
- Blood samples collected within 6 hours of symptom onset.
- Logistic regression analysis of blood biomarkers and National Institutes of Health Stroke Scale (NIHSS) for LVO prediction.
Main Results:
- 1177 patients analyzed; 262 had LVO.
- D-dimer was an independent predictor of LVO (OR, 1.59).
- Combined D-dimer and NIHSS improved specificity and positive predictive value for LVO detection compared to NIHSS alone.
Conclusions:
- Early D-dimer levels are a significant predictor of LVO.
- D-dimer may enhance prehospital triage accuracy for stroke patients.
- Optimized triage can facilitate faster transport to appropriate stroke centers.
Background And Purpose:
Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment.
Methods:
The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels.
Results:
One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31-1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone.
Conclusions:
Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
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