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Updated: Jul 6, 2025

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D-dimer as a Rule-Out for Aortic Dissection.

Jeremy M Carter1, Roshan B Tom1, Raheed Sunesra1

  • 1Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA.

Cureus
|January 8, 2024
PubMed
Summary

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Elevated D-dimer levels are highly sensitive for diagnosing acute aortic dissection (AAD). This finding suggests D-dimer testing can help rule out AAD in low-risk patients, potentially avoiding more invasive diagnostic procedures.

Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Hematology

Background:

  • Acute aortic dissection (AAD) presents diagnostic challenges due to varied symptoms and overlap with other conditions.
  • Current diagnostic tools like CT and echocardiography are not always feasible.
  • Limited research exists on D-dimer's utility in ruling out the rare condition of AAD.

Purpose of the Study:

  • To evaluate the sensitivity of elevated D-dimer levels in diagnosing AAD.
  • To assess D-dimer's utility in a large patient cohort.
  • To determine if D-dimer can help rule out AAD in suspected cases.

Main Methods:

  • Retrospective analysis of the TriNetX database, including 85 million patients from 54 US healthcare organizations over two decades.
  • Identification of 1,319 patients with confirmed AAD who underwent D-dimer testing within 24 hours of diagnosis.
Keywords:
acute aortic dissectioncardiovasculard-dimerdissection of thoracic aortaemergency medicine

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  • Evaluation of D-dimer sensitivity at cutoffs of 400 ng/ml and 500 ng/ml.

    • Main Results:

    • A D-dimer cutoff of 400 ng/ml demonstrated a sensitivity of 0.949 for AAD.
    • A D-dimer cutoff of 500 ng/ml yielded a sensitivity of 0.930 for AAD.
    • Out of 1,319 AAD patients, 1,252 had D-dimer >400 ng/ml and 1,227 had D-dimer >500 ng/ml.

    Conclusions:

    • Elevated D-dimer levels are highly sensitive for diagnosing acute aortic dissection (AAD).
    • D-dimer testing shows significant sensitivity in ruling out AAD.
    • This biomarker may help avoid unnecessary invasive testing in low-risk patients presenting with suspected AAD.