D-Dimer Testing in Ischemic Stroke and Cerebral Sinus and Venous Thrombosis

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

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Faculty Opinions recommendation of A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1090530.543802 ◽

2007 ◽

Author(s):

Ibrahim Bildirici

Keyword(s):

Blood Cell ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Red Blood Cell ◽

Cell Agglutination ◽

D Dimer ◽

In Pregnancy

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Anesthetic Management of a Child with β-Thalassemia Major and Cortical Venous Thrombosis

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0040-1715357 ◽

2020 ◽

Author(s):

Mayank Tyagi ◽

Surya K. Dube ◽

Vanitha Rajagopalan ◽

Gyaninder P. Singh

Keyword(s):

Venous Thrombosis ◽

Sinus Thrombosis ◽

Anesthetic Management ◽

Thalassemia Major ◽

Severe Form ◽

Thromboembolic Events ◽

Blood Disorders ◽

Decompressive Hemicraniectomy ◽

Cerebral Sinus ◽

Cortical Venous Thrombosis

Abstractβ-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.

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Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound

ISRN Radiology ◽

10.1155/2014/519875 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Maryam Rahiminejad ◽

Anshul Rastogi ◽

Shirish Prabhudesai ◽

David Mcclinton ◽

Peter MacCallum ◽

...

Keyword(s):

Risk Factor ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Clinical Risk Factor ◽

Diagnostic Pathway ◽

Clinical Diagnostic ◽

Retrospective Audit ◽

Wells Score ◽

D Dimer

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

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Successful treatment of Thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26. COV2 .S vaccination

American Journal of Hematology ◽

10.1002/ajh.26237 ◽

2021 ◽

Author(s):

Gemlyn George ◽

Kenneth D. Friedman ◽

Brian R. Curtis ◽

Stuart E. Lind

Keyword(s):

Venous Thrombosis ◽

Successful Treatment ◽

Cerebral Sinus Venous Thrombosis ◽

Cerebral Sinus ◽

Sinus Venous Thrombosis

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213 Thrombus imaging with 123I-labeled Fab fragments of two fibrin fragment D-dimer specific antibodies in a rabbit model of venous thrombosis

Fibrinolysis and Proteolysis ◽

10.1016/0268-9499(88)90560-7 ◽

1988 ◽

Vol 2 ◽

pp. 90 ◽

Cited By ~ 1

Author(s):

Y. Hashimoto ◽

J.M. Stassen ◽

D. Spriggs ◽

P. Holvoet ◽

A. Vandecruys ◽

...

Keyword(s):

Venous Thrombosis ◽

Rabbit Model ◽

Specific Antibodies ◽

Fab Fragments ◽

Thrombus Imaging ◽

D Dimer

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Abstract T P167: Emergent Identification of Type A Aortic Dissection as a Cause of Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp167 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tomoyuki Ohara ◽

Kazunori Toyoda ◽

Hiroyuki Yokoyama ◽

Kenji Minatoya ◽

Eijiro Tanaka ◽

...

Keyword(s):

Ischemic Stroke ◽

Back Pain ◽

Cerebral Ischemia ◽

Aortic Dissection ◽

Intravenous Thrombolysis ◽

Type A ◽

Neurological Deficits ◽

Diagnostic Tools ◽

Acute Cerebral Ischemia ◽

D Dimer

Background: Acute aortic dissection (AAD) sometimes presents with predominant neurological symptoms of acute cerebral ischemia. Fatal AAD patients after thrombolysis for stroke without noticing AAD were reported. The purpose of this study was to clarify the characteristics of AAD patients with acute cerebral ischemia and develop a score to emergently identify AAD for such patients. Methods: From the database of Stanford type A-AAD patients admitted in our hospital between 2007 and 2012, we selected those presenting with acute focal neurological deficits due to ischemic stroke/TIA. Patients presenting with shock state or cardiopulmonary arrest were excluded. Physiological, radiological, and blood examinations were assessed for AAD identification. Results: Of 187 AAD patients, 19 patients (10%) with focal neurological deficits as an initial presentation were studied. Involvement of one or more main branches of the aortic arch was observed in all of 19 patients. Stroke experts, not cardiovascular experts, were primarily called to ER in 18 patients, and 12 were potential candidates for intravenous thrombolysis. Left hemiparesis (14 patients, 74%) was the most common neurological symptom. Nine patients (47%) complained of chest or back pain. As components of the score, (1) systolic BP differential >20mmHg between upper extremities was present in 11 of 17 patients (65%), (2) mediastinal widening on chest radiography in 13/16 (81%), (3) occlusion or the intimal flap of the proximal common carotid artery on carotid ultrasonography in 14/16 (88%), (4) pericardial effusion on echocardiography in 10/19 (47%), and (5) abnormal elevation of D-dimer levels in all 19 (median 24.8 [range 4.2-406.2] μg/ml). Two components were positive in 4 patients, three in 6, four in 5, and all the five in 4. Conclusions: Only half of AAD patients with stroke/TIA complained of chest or back pain. All the AAD patients with stroke/TIA showed high D-dimer levels and one or more additional abnormal findings in physiological and radiological examinations. Combination of such handy diagnostic tools is helpful to identify AAD without long time delay and to avoid unnecessary thrombolysis for AAD patients.

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High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody–associated Vasculitis

The Journal of Rheumatology ◽

10.3899/jrheum.170896 ◽

2018 ◽

Vol 46 (3) ◽

pp. 285-293 ◽

Cited By ~ 18

Author(s):

Amy Kang ◽

Marilina Antonelou ◽

Nikki L. Wong ◽

Anisha Tanna ◽

Nishkantha Arulkumaran ◽

...

Keyword(s):

Ischemic Stroke ◽

Venous Thrombosis ◽

Independent Predictor ◽

Antineutrophil Cytoplasmic Antibody ◽

First Year ◽

High Incidence ◽

All Cause Mortality ◽

Coronary Events ◽

The Uk ◽

Event Rates

Objective.To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).Methods.This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.Results.There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1–10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.Conclusion.Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.

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