Do Normal D-dimer Levels Reliably Exclude Cerebral Sinus Thrombosis?

Abstract

Background and Purpose-Cerebral sinus thrombosis (CST) needs to be considered in the differential diagnosis of all patients with acute headache. Early diagnosis is essential because early treatment may prevent morbidity and may even be life-saving. Definite exclusion, however, needs advanced neuroradiologic diagnostics, which are not readily available in many hospitals. Because measurement of D-dimers has been demonstrated to be helpful in excluding thromboembolic disease, our aim was to investigate whether D-dimers would be also sensitive enough to exclude CST. Methods-We undertook a prospective multicenter study over a 2.5-year period including all patients who came to the emergency departments with symptoms suggestive of CST. All patients were diagnosed either by magnetic resonance venography, spiral computed tomography scan venography, or intra-arterial digital subtraction angiography. D-dimer levels were measured at admission and analyzed by the same method in all patients. Results-A total of 343 patients were included. CST was diagnosed in 35 patients, of whom 34 had D-dimers above the cutoff value (Ͼ500 g/L). From the 308 patients not having CST, D-dimers were elevated in 27. Sensitivity of D-dimers was 97.1%, with a negative predictive value of 99.6%. Specificity was 91.2%, with a positive predictive value of 55.7%. D-dimers were positively correlated with the extent of the thrombosis and negatively correlated with the duration of symptoms (Spearman rank correlation coefficients 0.76, Ϫ0.58, respectively). Conclusions-D-dimer

Diagnosis and Management of Cerebral Venous Thrombosis

“…In a well-designed prospective, multicenter study of 343 patients presenting to the emergency department with symptoms that suggested CVT, a positive D-dimer level (defined as a level Ͼ500 g/L) was found in 34 of 35 patients with confirmed CVT and 27 of 308 patients without CVT. 82 This yielded a sensitivity of 97.1%, a specificity of 91.2%, a negative predictive value of 99.6%, and a positive predictive value of 55.7%, which supports a clinically useful role of D-dimer in excluding CVT. A normal D-dimer level according to a sensitive immunoassay or rapid ELISA may help identify patients with a low probability of CVT.…”

“…A normal D-dimer level according to a sensitive immunoassay or rapid ELISA may help identify patients with a low probability of CVT. 82,83 A subsequent study of 73 patients with confirmed CVT found normal D-dimer levels in 7 patients (10%). 83 Five of the 7 patients with confirmed CVT and negative D-dimer presented with isolated headache, which suggests that this subgroup might be particularly at risk of false-negative results of D-dimer testing.…”

Cerebral Venous Thrombosis

“…5,9,10 In a study of 239 patients with suspected cerebral venous thrombosis, D-dimer testing was performed in 98 patients. 5 D-dimer testing was associated with a 9% false-positive rate and a 24% false-negative rate.…”

Two cases of venous sinus thrombosis in women taking the oral contraceptive pill, Yaz (dropirenone/ ethinyl estradiol), and review of the literature

“…A multicenter prospective study examined d-dimer sensitivity in the evaluation of CVT in which 35 patients were diagnosed with CVT and 34 had a positive d-dimer. When comparing to 308 patients without CVT, 27 had positive d-dimers, yielding a sensitivity of 97.1%, specificity of 91.2%, negative predictive value of 99.6%, and positive predictive value of 55.7% [32]. Negative d-dimer levels can help rule out CVT in patients with low suspicion for the diagnosis [23].…”