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Walter Ageno, MD; Sergio Finazzi, MD; Luigi Steidl, MD; Maria Grazia Biotti, MD; Valentina Mera, MD; GianVico Melzi d'Eril, MD; Achille Venco, MD

Arch Intern Med. 2002;162:2589-2593.

Background  Different coagulation abnormalities according to stroke subtypes have been reported. We have assessed the clinical utility of D-dimer, a product of fibrin degradation, in the early diagnosis of stroke subtypes.

Methods  Patients hospitalized after an acute ischemic cerebrovascular event underwent D-dimer assay (STA Liatest D-Dimer) (reference level, <0.50 µg/mL) on days 1, 6 ± 1, and 12 ± 1 and were studied to identify stroke subtypes.

Results  We included 126 patients (mean age, 75.5 years) and 63 age-matched control subjects. Stroke subtypes were cardioembolic in 34 patients (27%), atherothrombotic in 34 (27%), lacunar in 31 (25%), and unknown in 27 (21%). At all 3 measurements, D-dimer levels were significantly higher in the cardioembolic group (mean ± SEM, 2.96 ± 0.51, 2.58 ± 0.40, and 3.79 ± 0.30 µg/mL, respectively) than in the atherothrombotic (1.34 ± 0.21, 1.53 ± 0.26, and 2.91 ± 0.23 µg/mL, respectively) (P<.05) and lacunar (0.67 ± 0.08, 0.72 ± 0.15, and 0.64 ± 0.06 µg/mL, respectively) groups (P<.01). The difference was also significant between the latter 2 groups (P<.01). We found no difference between the lacunar group and controls (0.53 ± 0.14 µg/mL). According to day 1 measurements, the optimal cutoff point for predicting cardioembolic stroke was 2.00 µg/mL, resulting in a specificity of 93.2% and in a sensitivity of 59.3%. For predicting lacunar stroke, the cutoff point was 0.54 µg/mL, with a specificity of 96.2% and a sensitivity of 61.3%.

Conclusion  The increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with acute cerebrovascular ischemic events to help predict stroke subtype.

From the Departments of Clinical and Biological Sciences (Drs Ageno, Steidl, Mera, and Venco) and Clinical Chemistry (Dr Finazzi, Biotti, and Melzi d'Eril), University of Insubria, Varese, Italy.

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