Value of plasma fibrin D-dimers for detection of acute aortic dissection

Holger Eggebrecht, Christoph K Naber, Christian Bruch, Knut Kröger, Clemens von Birgelen, Axel Schmermund, Marc Wichert, Thomas Bartel, Klaus Mann, Raimund Erbel
Journal of the American College of Cardiology 2004 August 18, 44 (4): 804-9

OBJECTIVES: The purpose of this research was to assess the value of systemic inflammatory biomarkers in the detection of acute aortic dissection (AD).

BACKGROUND: Rapid diagnosis and initiation of treatment is pivotal for patients with acute AD. So far, there is no laboratory test to aid the diagnosis.

METHODS: Plasma fibrin D-dimers, white blood cell (WBC) count, C-reactive protein (CRP), and fibrinogen were determined in 64 chest-pain (CP) patients (acute AD, n = 16; pulmonary embolism [PE], n = 16; acute myocardial infarction [AMI], n = 16; non-cardiac CP, n = 16); 32 asymptomatic patients with chronic AD served as a control group.

RESULTS: All acute AD patients showed highly elevated D-dimer values that were similar to PE patients (2,238 +/- 1,765 microg/l vs. 1,531 +/- 837 microg/l, p = 0.15) but significantly higher than in chronic AD, AMI, or CP patients (p < 0.001). The WBC count was significantly increased in patients with acute AD compared with the other groups (p < 0.001); in addition, CRP values differed only non-significantly from PE patients(p = 0.71). There were no differences in the fibrinogen levels between the groups.

CONCLUSIONS: D-dimers are highly elevated in both acute PE and acute AD. Patients with acute AD show significant systemic inflammatory reactions. Measurement of D-dimers may be a valuable addition to the current diagnostic work-up of patients with suspected AD.

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