Key result
Preoperative D-dimer values were normal (<400 microg/l) in 18% of patients with confirmed acute aortic dissection, and showed no correlation with time from symptom onset (r = -0.232; P = 0.1).
Why the study?
Does a normal D-dimer level reliably rule out acute aortic dissection?
Observational (n=61)
Does a normal D-dimer level reliably rule out acute aortic dissection?
D-dimer testing has an imperfect negative predictive value for acute aortic dissection, as 18% of confirmed cases had normal levels, cautioning against its use to definitively rule out the diagnosis.
Answers are grounded in this paper and cite their sources.
Normal D-dimer cannot reliably exclude acute aortic dissection; leaves open its diagnostic value and warrants caution in algorithms.
In patients with acute aortic dissection, an early diagnosis is essential to anticipate aortic rupture, cardiac tamponade, organ ischemia and improve surgical results. A specific blood laboratory marker able to rule out the presence of aortic dissection has not been identified yet. Recently, several studies suggested using D-dimers as a negative predicting test to rule out diagnosis of acute aortic dissection in patients presenting with chest pain. In 61 patients with confirmed aortic dissection, preoperative D-dimers were assayed and correlated with time from symptom onset and extension of the false lumen dissection (according with De Bakey classification). Abnormal D-dimers values were considered those being greater than 400 microg/l. D-dimers values were above 400 microg/l in 50 patients (82%) and below 400 microg/l in 11 patients (18%). There was no correlation between preoperative D-dimers values and time from symptoms onset (r = -0.232; P = 0.1). We found that D-dimers are not always elevated in patients presenting with acute aortic dissection. Given the potential devastating effects of denying the diagnosis of acute aortic dissection with consequent delay of adequate treatment, a word of caution regarding the negative predictive value of D-dimer test in the diagnosis of aortic dissection seems warranted.
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Paparella et al. (2009) conducted an observational in acute aortic dissection (n=61). Preoperative D-dimer levels was evaluated on D-dimer elevation (>400 microg/l). Preoperative D-dimer values were normal (<400 microg/l) in 18% of patients with confirmed acute aortic dissection, and showed no correlation with time from symptom onset (r = -0.232; P = 0.1).
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