title: D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature.
abstract: BACKGROUND
  Quantitative measurement of circulating D-dimer, a product of fibrin degradation, has been shown to be a very useful diagnostic tool in the management of patients with suspected deep vein thrombosis and/or pulmonary embolism. Whether D-dimer can play a similar role in the diagnostic approach to patients with suspected cerebral vein thrombosis (CVT) remains controversial.
  
  
  METHODS
  Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of CVT were systematically searched for in the MEDLINE and EMBASE databases (up to July 2011). Weighted mean sensitivity and specificity with 95% confidence intervals (CIs) were calculated with a bivariate random-effects regression approach.
  
  
  RESULTS
  Fourteen studies, for a total of 1134 patients, were included. D-dimer accuracy was good, with a resulting weighted mean sensitivity of 93.9% (95% CI 87.5-97.1) and weighted mean specificity of 89.7% (95% CI 86.5-92.2), calculated with a bivariate approach. Potential risk factors for false-negative D-dimer results included isolated headache, longer duration of symptoms, and limited sinus involvement.
  
  
  CONCLUSIONS
  Our findings suggest that D-dimer may be a useful diagnostic tool in the management of patients with suspected CVT. Future prospective studies are warranted to confirm our preliminary findings.
authors.affiliation: Department of Clinical Medicine, Insubria University, Varese, Italy. fdentali@libero.it
authors.forename: F
authors.initials: F
authors.lastname: Dentali
authors.forename: A
authors.initials: A
authors.lastname: Squizzato
authors.forename: C
authors.initials: C
authors.lastname: Marchesi
authors.forename: M
authors.initials: M
authors.lastname: Bonzini
authors.forename: J M
authors.initials: JM
authors.lastname: Ferro
authors.forename: W
authors.initials: W
authors.lastname: Ageno
mesh_terms: D015415:Biomarkers / Q000097:blood; D005188:False Negative Reactions; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D020767:Intracranial Thrombosis / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D