title: Evaluation of plasma D-dimer plus fibrinogen in predicting acute CVST.
abstract: BACKGROUND
  Prompt diagnosis of cerebral venous sinus thrombosis is a challenge owing in part to its complex and non-specific early clinical symptoms.
  
  
  OBJECTIVE
  This study aims to evaluate the value of clinically useful biomarkers (d-dimer and fibrinogen) for cerebral venous sinus thrombosis prediction.
  
  
  METHODS
  Two-hundred and thirty-three suspected cerebral venous sinus thrombosis patients were enrolled in this prospective study. Thirty-four cases confirmed as cerebral venous sinus thrombosis using imaging modalities, whereas the other 199 cases served as mimic controls. Plasma samples of 34 healthy controls were further collected from age- and gender-matched volunteers. d-dimer and fibrinogen levels of all patients and controls were measured before imaging and treatment. The dynamic d-dimer and fibrinogen levels in cerebral venous sinus thrombosis cases after anticoagulation were monitored for up to 180 consecutive days.
  
  
  RESULTS
  At admission before treatment the average d-dimer and fibrinogen levels in cerebral venous sinus thrombosis group were 968·9 ± 160·1 μg/l and 6·9 ± 1·3 g/l, both of which were significantly elevated when compared with that of the controls. In cerebral venous sinus thrombosis patients, 94·1% had d-dimer elevation, 73·5% had fibrinogen elevation, and 67·6% had both elevated d-dimer and fibrinogen. During acute phase, the sensitivity and specificity of predicting cerebral venous sinus thrombosis using only d-dimer were 94·1% and 97·5%, whereas that of d-dimer in combination with fibrinogen were 67·6% and 98·9%. After administering anticoagulation, d-dimer levels gradually recovered; however, fibrinogen levels fluctuated with 33·3% of the patients still exhibiting elevated values up until 180 days.
  
  
  CONCLUSIONS
  d-dimer may serve as an important screening tool to determine the urgency of obtaining magnetic resonance imaging/magnetic resonance venography or digital subtraction angiography in patients presenting with clinical symptoms that are suspected of cerebral venous sinus thrombosis. Furthermore, d-dimer in combination with fibrinogen may increase the predictive value of acute cerebral venous sinus thrombosis.
authors.affiliation: Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience) and Neurology Department, Xuanwu Hospital, Capital Medical University, Key Lab of Neurodegenerative Diseases of Ministry of Education, Beijing, China; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Meng
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Wang
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hussain
authors.forename: David
authors.initials: D
authors.lastname: Dornbos
authors.forename: Lu
authors.initials: L
authors.lastname: Meng
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Wu
authors.forename: Mingming
authors.initials: M
authors.lastname: Ning
authors.forename: Buonanno
authors.initials: B
authors.lastname: Ferdinando S
authors.forename: Eng H
authors.initials: EH
authors.lastname: Lo
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012851:Sinus Thrombosis, Intracranial / Q000097:blood* / Q000175:diagnosis*; D013997:Time Factors; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: acute; cerebral venous sinus thrombosis; d-dimer; fibrinogen