Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Abstract

Background: Plasma <smlcap>D</smlcap>-dimer level may reflect the activity of thrombus formation in the left atrium of patients with nonvalvular atrial fibrillation (NVAF). Proper anticoagulation with warfarin dramatically decreases the rate of cerebral embolism, reduces stroke severity and subsequent risk of death, as well as the level of <smlcap>D</smlcap>-dimer in NVAF patients. However, the predictive value of <smlcap>D</smlcap>-dimer level on cerebral embolism severity has not been examined. Thus, the purpose of this study was to investigate the association between plasma <smlcap>D</smlcap>-dimer level at admission and infarct size in NVAF patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 h of symptom onset. We measured infarction volume from CT taken after 3 ± 1 days from the onset. Plasma <smlcap>D</smlcap>-dimer levels were measured at the time of admission. Relationships were analyzed between infarction volume and plasma <smlcap>D</smlcap>-dimer levels, cardiovascular risk factors, preadmission medications and admission conditions. We also assessed the influence of <smlcap>D</smlcap>-dimer level on functional outcome in patients with preadmission modified Rankin Scale (mRS) score of 0–1 and patients by tertile of <smlcap>D</smlcap>-dimer level (≤0.83, 0.83–2.16 and ≥2.16 µg/ml). Results: Infarction volume significantly correlated with <smlcap>D</smlcap>-dimer level (r = 0.309, p < 0.001), systolic blood pressure (r = 0.201, p = 0.026), diastolic blood pressure (r = 0.283, p = 0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r = 0.546, p < 0.001) and mRS score at discharge (r = 0.557, p < 0.001). Multivariate regression analyses showed that the <smlcap>D</smlcap>-dimer level was significantly associated with infarction volume after adjusting for age, sex, current smoker or not, prothrombin time-international normalized ratio ≥1.6, diastolic blood pressure, CHADS₂ score and NIHSS score on admission. In patients with a preadmission mRS score of 0–1 (n = 108), <smlcap>D</smlcap>-dimer level was significantly associated with NIHSS score at admission (r = 0.318, p < 0.001) and mRS score at discharge (r = 0.310, p = 0.001). Patients in the highest <smlcap>D</smlcap>-dimer tertile group showed worse outcome than those in the middle (p = 0.041) and lowest (p < 0.001) tertiles. Conclusions: Plasma <smlcap>D</smlcap>-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.

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

“…In addition, multiple studies have shown that D-dimer levels can effectively predict subsequent embolic events in patients with NVAF, even during oral anticoagulant therapy [15,16,17,18,19]. Matsumoto et al [20] demonstrated that the plasma D-dimer level was significantly associated with infarction volume and poor functional outcome in NVAF patients with cardioembolic stroke. However, few studies have evaluated the D-dimer level in hyperthyroid patients with AF.…”

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

“…A study by Matsumoto whose data could not be included found a link between low D-dimer concentrations and a good outcome at discharge. They did not mention the length of stay in the hospital [37]. The discrepancy in individual findings cannot be explained by different measuring points in time.…”

Ischemic Stroke

“…The expression of vascular endothelial growth factor (VEGF) was correlated with infarct volume and clinical disability (Scandinavian Stroke Scale) [ 22 ]. D -dimer levels at admission were also associated with total infarct volume in patients with acute ischemic stroke and atrial fi brillation [ 23 ]. The excitatory neurotransmitter glutamate was associated with infarct growth [ 24 ].…”