title: [Acute aortic dissection: diagnostic usefulness of D-dimer].
abstract: Acute aortic dissection (AAD) is uncommon, and associated with high morbidity and mortality rates. Positive or negative likelihood ratios of clinical parameters, ECG and chest x-ray do not allow to rule in or rule out AAD. Angio-CT, transoesophageal echocardiography, and MRI are validated tools for AAD diagnosis, although they are invasive and associated with significant complications. In several studies, D-dimer level within the normal range appears to have a negative predictive value that is low enough to rule out AAD. However, flaws of study design, heterogeneity of D-dimer tests and of their cut-offs (from 100 to 900 microg/l), and the absence of a validated workup strategy are strong arguments against the current use of D-dimer as a unique test to rule out AAD in clinical practice.
authors.affiliation: Service de médecine interne, CHUV, 1011 Lausanne. Yvan.Fournier@chuv.ch
authors.forename: Yvan
authors.initials: Y
authors.lastname: Fournier
authors.forename: Paul-André
authors.initials: PA
authors.lastname: Moix
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000097:blood* / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000097:blood* / Q000175:diagnosis*; D003663:Decision Trees; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D