D-dimer as the sole screening test for acute aortic dissection: a review of the literature.

Recent studies have proposed the use of D-dimer as a screening tool to "rule out" acute aortic dissection, claiming a sensitivity approaching 100%. We reviewed the literature to determine whether D-dimer can be used as the sole screening tool for acute aortic dissection. An Ovid MEDLINE search, 1966 to present, was performed with the key words "aortic dissection," "fibrin degradation products," and "D-dimer," limited to "human" and "English language." Ten original research articles were identified that directly addressed the use of D-dimer in acute aortic dissection. There appears to be a subset of patients with acute aortic dissection who develop intramural hematomas, frequently found to have low or negative D-dimer levels. In addition, none of the studies reviewed defined a specific patient population eligible for D-dimer screening, and many of the studies had wide sensitivity confidence intervals (CIs) because of low patient numbers. Despite a high sensitivity, D-dimer cannot be recommended as the sole screening tool for acute aortic dissection. Ten per 100,000 Americans will have an acute aortic dissection, and missing the diagnosis may be catastrophic. A definitive diagnosis of aortic dissection largely relies on advanced radiographic imaging, either invasive or noninvasive. However, 38% of dissections are missed on initial evaluation, and there are no validated clinical decision rules for the clinical diagnosis of acute aortic dissection. Clinical suspicion and chest radiograph findings were the only tools for determining which patients require further imaging until recent studies proposed the use of D-dimer as a screening tool for acute aortic dissection, claiming a sensitivity approaching 100%. Our goal was to evaluate the current literature for the use of D-dimer as the sole screening tool for acute aortic dissection.