D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a HORIZONS-AMI biomarker substudy

Abstract

D-dimer is a product of cross linked fibrin degradation and is a measure of the amount of fibrin turnover. As such, D-dimer might be of utility in the prediction of both thrombotic and hemorrhagic events. Therefore, the aim of the present study was to evaluate whether elevated D-dimer levels on admission and at discharge could predict subsequent ischemic and hemorrhagic events in patients with acute myocardial infarction (AMI). D-dimer was measured on admission and at discharge in 461 out of a total of 3,602 patients in the HORIZONS-AMI trial, as part of the formal prespecified biomarker substudy. The predictive value for major adverse cardiovascular events (MACE) and non-CABG major bleeding after 3 year follow up was investigated by stratifying patients in groups of D-dimer level and comparing event rates using Kaplan-Meier and calculating hazard ratios using Cox proportional hazards models. D-dimer levels ≥ 0.71 μg/mL on admission were associated with an adjusted hazard ratio of 2.58 for MACE (p = 0.0014) and 4.61 for major bleeding (p = 0.0018). A discharge D-dimer level ≥ 1.26 μg/mL was associated with a higher risk for MACE by univariate analysis (HR 1.88, p = 0.037), but lost its significance after multivariate adjustment (HR 1.77, p = 0.070). High D-dimer levels on admission were associated with a higher risk of MACE and non-CABG major bleeding in STEMI patients undergoing pPCI.

High Plasma D-Dimer Indicates Unfavorable Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis

“…Only one report showed that higher levels of D-dimer can predict systemic bleeding (including intracranial hemorrhage) in acute myocardial infarction [19] . The mechanism of the independent association between higher D-dimer and symptomatic ICH in our study may be similar to the aforementioned.…”

D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

“…Ddimer, a product of cross-linked fibrin degradation, is a measure of the amount of fibrin turnover and might be of utility in the prediction of both thrombotic and hemorrhagic adverse events (12). Currently, emerging evidence endorses a 'predictive' role for increased D-dimer levels, since its measurement provides prognostic data for a variety of conditions, including venous thromboembolism, cardiovascular diseases, infectious diseases, and cancer (13)(14)(15)(16)(17)(18).…”

“…In such a condition, infectious disease like IE leads to increased morbidity and mortality(37). Circulating concentration of D-dimer is an activation marker of fibrinolysis and, therefore, of coagulation and reflects the extent of fibrin turnover(12).Recently, increased D-dimer level emerged as a significant predictor of morbidity and mortality in various clinical conditions including venous thromboembolism, cardiovascular diseases like myocardial infarction and aortic dissection, infectious diseases like sepsis, and cancer(13)(14)(15)(16)(17)(18)38). In a study including 42 patients, Bakal et al (39) showed that plasma Ddimer levels have been increased in patients with IE who suffered from clinically significant systemic embolism and D-dimer >425 ng/dl demonstrated a sensitivity of 77% and specificity of 62% for the prediction of clinical embolism.…”

Predictive Value of Admission D-dimer for Contrast-induced Acute Kidney Injury and Poor Outcomes after Primary Percutaneous Coronary Intervention

“…In recent years, DD had been reported to be a marker for the early diagnosis of ACS presenting with chest pain [8] and acute myocardial infarction (AMI) [9] . Furthermore, DD had been found to be associated with short-, mid-and long-term poor outcomes in patient with AMI [10][11][12] . In addition, as a marker of increased coagulability and fibrinolysis, DD also had been documented to be associated with renal insufficiency, which indicated that DD concentration increased significantly with increasing creatinine levels [13] or decreasing estimated glomerular filtration rate(GFR) [14] .…”