European Heart Journal Advance Access originally published online on November 6, 2007
European Heart Journal 2007 28(24):3067-3075; doi:10.1093/eurheartj/ehm484
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D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study
1 Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
2 Department of Angiology, Vienna General Hospital, Medical University Vienna, Vienna, Waehringer Guertel 18-20, A- 1090 Vienna, Austria
3 Department of Cardiothoracic Surgery, Medical University Vienna, Vienna, Austria
4 Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
Received 23 March 2007; revised 19 September 2007; accepted 28 September 2007; online publish-ahead-of-print 6 November 2007.
* Corresponding author. Tel: +43 1 40400 1964; fax: +43 1 40400 1965. E-mail address: hans.domanovits{at}meduniwien.ac.at
Aims: Blood D-dimer testing has been proposed as diagnostic marker with high sensitivity for exclusion of acute aortic dissection (AAD). We performed a systematic review and validated the findings in a prospective patient cohort.
Methods and results: We searched MEDLINE, EMBASE, CINAHL, and BIOSIS from inception until January 2007 using a combination of search terms for aortic dissection and D-dimer. Study type, type of assay used, predefined cut-off level, result of D-dimer testing, sensitivity, and specificity were abstracted. In 16 identified studies (437 patients), the reported cut-off values ranged from 0.1 to 0.9 µg/mL. D-dimer testing provided high sensitivity (0.97 95% CI 0.94–0.98) and negative likelihood ratio (0.06 95% CI 0.02–0.13). In our cohort of 65 patients (36 male, 55%; median age 59 years, IQR 49–67) with proven AAD, D-dimer levels scattered from 0.24 to 137.88 µg/mL (median 3.47; IQR 1.55–14.49). Mean NPV for the different cut-off levels ranged from 92 % for a cut-off level of 0.9 µg/mL to 100% for a cut-off level of 0.1 µg/mL in our study population.
Conclusion: Current evidence supports a routine measurement of D-dimer in excluding AAD. A D-dimer <0.1 µg/mL will exclude AAD in all cases.
Key Words: Aortic dissection • Diagnosis • D-dimer
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