d -Dimer Predicts Early Clinical Progression in Ischemic Stroke

Abstract

Background and Purpose-Plasma D-dimer levels, measured using a research laboratory assay, independently predict progressing ischemic stroke. We wished to confirm these findings using commercially available assays and to provide data to allow the design of intervention studies. Methods-We studied 219 consecutive acute ischemic stroke admissions of whom 54 (25%) met criteria for progressing stroke. Results-There were strong correlations between D-dimer results as measured by the Biopool AB, MDA and VIDAS assays; correlation coefficients rϭ0.91 to 0.94; all PϽ0.001. In binary logistic regression analyses, D-dimer, as measured by the 3 different assays, was an independent predictor of progressing stroke (odds ratios, 1.87 to 2.45; all PϽ0.001). This confirms the results of our original analysis (Biopool AB) using 2 commercial D-dimer assays, demonstrating the potential usefulness of D-dimer in providing early prognostic information after ischemic stroke in different clinical settings. We also provide information on the performance of the 3 assays in predicting progressing stroke at a variety of cutoff values. Conclusions-Ischemic stroke patients at high risk of early progression can be identified using commercial D-dimer measurements. This could allow selection of high-risk patients for inclusion in randomized trials of early antithrombotic treatments. Key Words:arly clinical progression of ischemic stroke is common and is associated with poor prognosis. 1 D-dimer levels are elevated in the acute phase of stroke and subsequently fall. [2][3][4] We previously demonstrated that plasma D-dimer levels (along with mean arterial blood pressure) independently predict progressing ischemic stroke. 5 This measurement of D-dimer was performed with a commercially available ELISA from Biopool AB used in our research laboratory. We wished to confirm our findings using other commercially available assays commonly used by hospital laboratories, particularly the MDA and VIDAS D-dimer assays. Materials and MethodsWe studied consecutive ischemic stroke admissions. 5 Progressing stroke was defined using a modification of the European Progressing Stroke Study definition. 6 This requires deterioration in conscious level, arm or leg weakness, or speech over 72 hours following admission. Blood was taken within 24 hours of symptom onset, and plasma samples were stored at Ϫ80°C before analysis. The MDA D-dimer assay is an automated latex particle-based immunoassay, and the VIDAS D-dimer assay is an automated enzyme-linked fluorescent assay. 7 Univariate analysis of D-dimer levels used unpaired t tests of natural log-transformed levels. Correlations between the different assays were calculated using the Spearman rank method. Multivariate analysis was performed using a stepwise binary logistic regression procedure including variables when significance was found to be PϽ0.10 in univariate analysis. ResultsFifty-four (25%) of the 219 patients recruited met the criteria for progressing stroke. Table 2 shows the sensitivity, specificity, and po...

Inflammatory and Hemostatic Biomarkers Associated With Early Recurrent Ischemic Lesions in Acute Ischemic Stroke

“…14 D-dimer is known to be positively associated with coronary heart disease incidence 18,19 and its recurrence, 20 which is largely independent of conventional risk factors. 21 D-dimer has also been shown to predict early clinical progression in ischemic stroke 22,23 and poor functional outcome after acute spontaneous intracerebral hemorrhage 24 and subarachnoid hemorrhage. 25 There are several plausible mechanisms through which D-dimer levels could be closely related to ERILs.…”

Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke

“…Many studies have shown elevated D-dimer levels during the acute phase of stroke, which eventually fall 14,26,30,34) . However, previous studies have demonstrated only that plasma D-dimer levels predict a progressing ischemic stroke 4,5) . We studied the relationship between D-dimer level and infarction volume and the relationship between D-dimer change and clinical outcome in AIS.…”

D-Dimers Predict Stroke Subtype when Assessed Early

“…Limited data are available on coagulation markers very early after symptom onset, as the majority of previous studies were performed >12 h after symptom onset [3,5,6,7,8,10,11,12,13,14]. D-dimer levels have been shown to be associated with cardioembolic strokes [4,6,7,8,9,10,12,14], yet their significance in acute stroke remains to be determined.…”