Tomoyuki Ohara1,2, Mehdi Farhoudi1,3, Oh Young Bang4, Masatoshi Koga5, Andrew M Demchuk1. 1. Calgary Stroke Program, Hotchkiss Brain Institute, Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine University of Calgary, Calgary, Canada. 2. Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran. 4. Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea. 5. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Abstract
BACKGROUND: Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. AIMS: To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. SUMMARY: D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. CONCLUSION: Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.
BACKGROUND: Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. AIMS: To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. SUMMARY: D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. CONCLUSION: Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.
Authors: Babak B Navi; Scott E Kasner; Mitchell S V Elkind; Mary Cushman; Oh Young Bang; Lisa M DeAngelis Journal: Stroke Date: 2021-01-28 Impact factor: 7.914
Authors: Babak B Navi; Carla P Sherman; Richard Genova; Ryna Mathias; Kelsey N Lansdale; Natalie M LeMoss; Julia Wolfe; Anna Skakodub; Hooman Kamel; Scott T Tagawa; Ashish Saxena; Allyson J Ocean; Gerald A Soff; Maria T DeSancho; Costantino Iadecola; Mitchell S V Elkind; Ellinor Peerschke; Cenai Zhang; Lisa M DeAngelis Journal: Ann Neurol Date: 2021-06-03 Impact factor: 11.274