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d-Dimer With the Aortic Dissection Detection Risk Score May Improve Patient Selection for Acute Aortic Syndrome

Sameer Bhat1,2, Shreya Bhat3, Franco Schreve4

  • 1Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Emergency Medicine Australasia : EMA
|January 26, 2026
PubMed

Insights

A negative d-dimer test effectively rules out acute aortic syndrome (AAS) in low-risk patients. This finding supports using d-dimer to avoid unnecessary computerised tomographic aortography (CTA) scans for suspected AAS.

Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Acute aortic syndrome (AAS) is a life-threatening condition requiring definitive diagnosis via computerised tomographic aortography (CTA).
  • Current risk-stratification tools for AAS, like the aortic dissection detection risk score (ADD-RS), lack validation in low-to-intermediate risk populations.
  • There is a need for effective methods to identify patients who do not require advanced imaging for suspected AAS.

Purpose of the Study:

  • To evaluate the diagnostic efficacy of d-dimer testing in identifying AAS in patients with low or intermediate pre-test probability.
  • To determine the sensitivity and negative predictive value (NPV) of a negative d-dimer result in ruling out AAS.
  • To analyze trends in d-dimer test utilization for suspected AAS over time.

Main Methods:

  • Retrospective analysis of atraumatic thoracic CTAs in adults suspected of AAS presenting to the emergency department.
  • Aortic dissection detection risk score (ADD-RS) was used to stratify patients into low/intermediate (ADD-RS ≤ 1) and high-risk groups.
  • Calculation of sensitivity and NPV for d-dimer (< 500 ng/mL) in the low/intermediate risk group.

Main Results:

  • In 181 low/intermediate risk patients, a negative d-dimer (< 500 ng/mL) demonstrated 100% sensitivity and 100% NPV for ruling out AAS.
  • A significant increase in annual d-dimer requests for patients undergoing CTA for suspected AAS was observed (p=0.0059).
  • The proportion of negative d-dimer results increased significantly (p=0.0036), while positive results remained stable.

Conclusions:

  • A d-dimer level below 500 ng/mL can reliably exclude AAS in low-to-intermediate risk patients.
  • This biomarker may help clinicians avoid unnecessary computerised tomographic aortography (CTA) scans in this patient cohort.
  • The findings support the judicious use of d-dimer as a rule-out test for AAS in selected emergency department presentations.
Abstract

Keywords:
accuracyaortic dissectionaortic dissection detection risk scorecomputer assisted tomographyfibrin fragment d

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