D-Dimers Predict Stroke Subtype when Assessed Early

Abstract

Background:Early classification of ischemic stroke subtype is important for secondary stroke prevention and may guide further investigations. Methods: Levels of coagulation activation [fibrinopeptide A (FPA), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT)] and fibrinolysis activation [plasmin-α₂-antiplasmin complex (PAP), D-dimers] markers were measured in 98 consecutive patients with a first-ever acute ischemic stroke admitted within 12 h after symptom onset. Results: Median age was 67 years and 44% were women. Median time from symptom onset to blood sampling was 4 h. Stroke subtype was classified as ‘cardioembolic’ (54%), ‘large-artery atherosclerosis’ (11%), ‘small-vessel disease’ (5%), ‘other determined’ (9%) or ‘undetermined etiology’ (20%). Patients with cardioembolic stroke suffered more often from coronary artery disease than patients with other stroke etiologies (40 vs. 22%, p = 0.019). There were no differences in age, sex, stroke severity, time to blood sampling, frequency of hypertension, diabetes mellitus or current smoking. D-dimers (medians) were higher in patients with cardioembolic strokes than in those with other etiologies (615 vs. 322 μg/l, p < 0.001). No differences in F1+2, FPA, TAT or PAP levels were found. After multivariate analysis, higher D-dimer levels remained independently associated with cardioembolic stroke (p = 0.022). When measured within 6 h, D-dimers below 300 μg/l excluded cardioembolic stroke with a sensitivity of 100% and a specificity of 52%. Conclusions: Low D-dimer levels in the first few hours make a cardioembolic stroke unlikely, and may be useful to guide further investigations. Other coagulation markers were not useful in differentiating between different stroke etiologies.

Cancer-Associated Hypercoagulation Increases the Risk of Early Recurrent Stroke in Patients with Active Cancer

“…However, these findings are not direct evidence of cancer-associated hypercoagulation and also seen in cardioembolic stroke. Nevertheless, the cut off D-dimer value of 10.4 µg/mL for hDD in our study was quite higher than D-dimer values observed in cardioembolic stroke [23][24][25]. Also, previous studies have suggested that MVTI was more sensitive to presumed cancer-associated stroke than cardioembolic stroke [1,3,11,[26][27][28].…”

Blood Biomarkers of Ischemic Stroke

“…D-Dimer has been associated with cardioembolic stroke in other studies, with Ageno et al reporting a D-Dimer level >2.0 ug/mL to be predictive of cardioembolic stroke with specificity of 93.2% and sensitivity of 59.3% [36,37]. A more recent study confirms these findings [38]. BNP has also been associated with embolism in patients with atrial fibrillation [39,40].…”

Time course of NT-proBNP levels after acute ischemic stroke

“…The possibility of an increased time window for NT-proBNP measurements is an important possible advantage of the use of NT-proBNP instead of BNP in this setting, as NT-pro BNP is known to have an increased half-life (18). This extended time window of 72 hours can also have an advantage over the user of D-dimers for the diagnosis of cardioembolic stroke, which were found to be potentially useful for the diagnosis of cardioembolic stroke in the first 12 hours after ischemic stroke (19).…”