D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study.
OBJECTIVE
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.


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 microg/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 microg/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 microg/mL to 100% for a cut-off level of 0.1 microg/mL in our study population.


CONCLUSIONS
Current evidence supports a routine measurement of D-dimer in excluding AAD. A D-dimer <0.1 microg/mL will exclude AAD in all cases.
Sodeck
Gottfried
G
Department of Emergency Medicine, Medical University Vienna, Vienna, Austria.
Domanovits
Hans
H
Schillinger
Martin
M
Ehrlich
Marek P
MP
Endler
Georg
G
Herkner
Harald
H
Laggner
Anton
A
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D