This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (24)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • Stroke  • Alert me on articles by topic  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Etiologic Diagnosis of Ischemic Stroke Subtypes With Plasma Biomarkers
Montaner et al.
Stroke 2008;39:2280-2287.
ABSTRACT | FULL TEXT  

Right-to-left shunt and lacunar stroke in patients without hypertension and diabetes
Ueno et al.
Neurology 2007;68:528-531.
ABSTRACT | FULL TEXT  

Are There Patients With Acute Ischemic Stroke and Atrial Fibrillation That Benefit From Low Molecular Weight Heparin?
O'Donnell et al.
Stroke 2006;37:452-455.
ABSTRACT | FULL TEXT  

Closure of patent foramen ovale in cryptogenic stroke: Ready or not, here come the trials
Blackshear
J Am Coll Cardiol 2004;44:759-761.
FULL TEXT  

Stroke in patients with cancer: Incidence and etiology
Cestari et al.
Neurology 2004;62:2025-2030.
ABSTRACT | FULL TEXT  

Hemostatic Function and Progressing Ischemic Stroke: D-dimer Predicts Early Clinical Progression
Barber et al.
Stroke 2004;35:1421-1425.
ABSTRACT | FULL TEXT