Key result
D-dimer testing aids acute aortic dissection rule-out, though high false-positive rates limit emergency utility.
Why the study?
Aortic dissection is challenging to rapidly diagnose in the emergency setting while avoiding costly imaging that may cause further complications, and the viability of D-dimer testing as a diagnostic tool needed exploration.
Does D-dimer testing combined with diagnostic algorithms improve the diagnosis and rule-out of aortic dissection in patients in the emergency setting?
Does D-dimer testing combined with diagnostic algorithms improve the diagnosis and rule-out of aortic dissection in patients in the emergency setting?
Combining D-dimer testing with new diagnostic methods shows promise for ruling out acute aortic dissection and reducing false positives in the emergency setting, though large multicenter validation is still required.
Answers are grounded in this paper and cite their sources.
May support aortic dissection rule-out in emergencies but should not yet change practice; leaves open standardized algorithms and multicenter validation.
As an acute, life-threatening condition, aortic dissection (AD) poses a challenge to rapidly diagnose in the emergency setting while ensuring patients do not undergo costly imaging that may cause further complications. D-dimer, a biomarker found to be elevated in AD patients, may be a promising diagnostic tool. This review attempts to explore the research that has tackled the viability of this proposition. An extensive search of PubMed, PubMed Central, Europe PMC, Google Scholar, and Cochrane Library, focusing on English-language publications made between 2009 and January 2025, yielded many articles of interest. Chronologically, the former of these publications identified D-dimer as a promising tool for raising suspicion of AD. Afterward, studies were conducted to explore the prospects of combining D-dimer testing with methods already used for raising suspicion of AD, which yielded significant results for ruling out AD. However, due to the still high false positive rates when using these combinations, and the inherent difficulties of using the algorithm in the emergency setting, the newest studies focused on combining D-dimer testing with other new methods to decrease high false positive rates as well as ensure the algorithm is simple enough to be used easily in emergencies. In conclusion, while the latest publications yield promising results for diagnostic values, further large-scale international multicenter studies are needed to verify their accuracy, as well as to establish a standardized algorithm, and to calculate the effect any algorithm has on cost-effectiveness and quality of care.
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Khattab et al. (2026) conducted a review in Aortic dissection. D-dimer testing (alone or combined with clinical decision methods/algorithms) was evaluated on Diagnosis and rule-out of acute aortic dissection. D-dimer testing combined with clinical methods shows promise for ruling out acute aortic dissection, though high false positive rates and lack of a standardized emergency algorithm remain challenges.
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