D-dimer determination as a screening tool to exclude atrial thrombi in atrial fibrillation

Somlói, Miklós; Tomcsányi, János; Nagy, Erzsébet; Bodó, Imre; Bezzegh, Attila

doi:10.1016/s0002-9149(03)00476-4

Cited by 45 publications

(32 citation statements)

References 18 publications

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“…Furthermore, numerous studies have shown that the D-dimer level can be a useful marker of the absence of left atrial appendage thrombi and subsequent embolic events in patients with NVAF, even during oral anticoagulation [15,16,17,18,19]. Meanwhile, in combination with CHADS 2 scores, the D-dimer level can effectively predict subsequent thromboembolic events in patients with NVAF [39,40]. Our results have shown that both age and CHA 2 DS 2 -VASc score, irrespective of the D-dimer level, were two independent predictors for the occurrence of ischemic stroke in patients with hyperthyroid AF.…”

Section: Discussionmentioning

confidence: 99%

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

et al. 2014

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Objective: To clarify whether hyperthyroidism (HT) itself confers an additional effect on the hypercoagulable state and the risk of ischemic stroke among patients with hyperthyroid atrial fibrillation (AF). Methods: We prospectively evaluated plasma D-dimer levels and thromboembolic events among three groups of patients (hyperthyroid AF, n = 62; nonthyroid AF, n = 107, and HT without AF, n = 100). Plasma D-dimer levels were used to evaluate the hypercoagulable state. Results: The D-dimer level was significantly higher in patients with hyperthyroid AF than in nonthyroid AF (0.66 ± 0.06 vs. 0.34 ± 0.02 mg/l, p < 0.001) and HT without AF (0.66 ± 0.06 vs. 0.27 ± 0.02 mg/l, p < 0.001). During a 3-year follow-up, patients with hyperthyroid AF had a significantly higher incidence of ischemic stroke compared with patients with nonthyroid AF (hazard ratio, HR: 3.2, 95% confidence interval, CI: 1.01-5.59, p = 0.04). Cox regression analysis revealed that age (HR: 2.5, 95% CI: 1.01-1.21, p = 0.05), CHADS₂-VAS score (HR: 5.5, 95% CI: 1.51-7.43, p = 0.01) and anticoagulation (HR: 0.45, 95% CI: 0.07-0.54, p = 0.01) were independent predictors of risk for the occurrence of ischemic stroke. Conclusions: The present study suggests that HT may enhance the hypercoagulable state and the risk of ischemic stroke in patients with AF.

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Section: Discussionmentioning

confidence: 99%

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

et al. 2014

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“…The development of monoclonal antibodies specific for D-dimer has enabled accurate quantification of cross-linked fibrin degradation products. The role of the D-dimer assay in the diagnosis and prognosis of cardiovascular disease has been extensively studied (7,8). We have presented a case in which the D-dimer assay was used in the inclusion and exclusion of atrial thrombosis before cardioversion in a patient with AF who refused to undergo TEE.…”

Section: Discussionmentioning

confidence: 99%

“…Because both conventional use of anticoagulation and TEE in the management of AF have documented pitfalls, there is a need to improve the evaluation of patients before cardioversion. A prospective study (8) analyzing the Ddimer assay as a screening tool for the exclusion of atrial thrombi has shown that it may be a better single marker of overall thromboembolic risk than TEE. Low levels of D-dimer have been shown to exclude atrial thrombi (8); hence, the D-dimer assay is a possible adjunctive tool in the diagnostic evaluation of atrial thrombosis in addition to TEE.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective study (8) analyzing the Ddimer assay as a screening tool for the exclusion of atrial thrombi has shown that it may be a better single marker of overall thromboembolic risk than TEE. Low levels of D-dimer have been shown to exclude atrial thrombi (8); hence, the D-dimer assay is a possible adjunctive tool in the diagnostic evaluation of atrial thrombosis in addition to TEE. In a recent prospective animal study (12), we showed a potential role of minidose tissue plasminogen activator in enhancing the D-dimer signal in situ in deep venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

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The D-dimer assay: A possible tool in the evaluation of atrial thrombosis

Ibebuogu

Salah

Malhotra

et al. 2008

Canadian Journal of Cardiology

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A trial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice, and affects more than 4% of the population older than 60 years of age (1,2). Peripheral thromboembolism and ischemic stroke contribute significantly to the observed mortality and morbidity rates. AF contributes to 15% to 20% of all strokes (1,3), and emboli arise predominantly from the left atrial appendage (LAA) (4). Hence, there is a need to exclude atrial thrombi before cardioversion in symptomatic AF. A recent large, randomized controlled trial has shown that negative transesophageal echocardiography (TEE) results may obviate the need for prolonged anticoagulation before cardioversion, with no significant difference in embolic events compared with conventional therapy (5). Because of the complex multilobed configuration of the LAA and the minute size of clinically significant thrombi, there are inherent limitations in using a nontomographic technique for visualization of the LAA. Using the two-dimensional beam of TEE in visualizing the three-dimensional anatomy of the LAA is analogous to using a searchlight to visualize the entire roof of a cave, which is technically difficult to achieve completely. Studies have shown that embolism may presumably occur after cardioversion of AF, despite apparent exclusion of a pre-existing atrial thrombus by TEE (6). Plasma D-dimer constitutes an antigen-antibody reaction to the dimeric final degradation product of a mature clot. An elevated fibrin D-dimer has a high sensitivity for intravascular thrombus (7) and may improve the evaluation of a patient with AF before cardioversion. CASE PRESENTATIONA 56-year-old man eight years post-renal transplant and four years post-coronary artery bypass surgery, as well as a history of adequately treated, methicillin-resistant Staphylococcus epidermidis bacteremia, CASE REPORT ©2008 Pulsus Group Inc. All rights reserved Atrial fibrillation (AF) is a common arrhythmia seen in clinical practice, and affects more than 4% of the population older than 60 years of age. Peripheral thromboembolism contributes significantly to the observed morbidity and mortality. Symptomatic AF, before cardioversion to normal sinus rhythm, requires either exclusion of atrial thrombi using transesophageal echocardiography (TEE) or the conventional use of three weeks of adequate anticoagulation. The exclusion of atrial thrombi by TEE, a nontomographic technique but comparable with conventional treatment of AF in outcomes, has inherent limitations due to the complex three-dimensional multilobed anatomy of the left atrial appendage, where the majority of atrial thrombi arise. Also, the conventional treatment of three weeks of therapeutic anticoagulation before cardioversion reportedly does not always eliminate atrial thrombi. Plasma D-dimer constitutes an antigen-antibody reaction to the dimeric final degradation product of a mature clot. An elevated fibrin D-dimer has a high sensitivity for intravascular thrombosis and, hence, may improve the evaluation of a patient with A...

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“…Increasing D-dimer levels may reflect atrial thrombus formation and higher embolic risks in patients with AF, 8 and anticoagulant therapy may decrease D-dimer levels. 9 The relationship between anticoagulation control quality and D-dimer levels in patients with AF has not been thoroughly evaluated, so we prospectively examined it in the present study.…”

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confidence: 99%

Anticoagulation Control Quality Affects the D-Dimer Levels of Atrial Fibrillation Patients

Nakatani

Mizumaki

Nishida

et al. 2012

Circ J

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D-dimer determination as a screening tool to exclude atrial thrombi in atrial fibrillation

Cited by 45 publications

References 18 publications

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

The D-dimer assay: A possible tool in the evaluation of atrial thrombosis

Anticoagulation Control Quality Affects the D-Dimer Levels of Atrial Fibrillation Patients

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