Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2008 Jun;24(6):517-9.
doi: 10.1016/s0828-282x(08)70629-9.

The D-dimer assay: a possible tool in the evaluation of atrial thrombosis

Uzoma N Ibebuogu  1 , Ali K Salah, Surender Malhotra, Joe B Calkins Jr, John W Thornton 3rd, Mahendra Mandawat, Vincent J B Robinson
Affiliations
Case Reports

The D-dimer assay: a possible tool in the evaluation of atrial thrombosis

Uzoma N Ibebuogu et al. Can J Cardiol. 2008 Jun.

Abstract
in English, French

Atrial fibrillation (AF) is a common arrhythmia seen in clinical practice, and affects more than 4% of the population older than 60 years of age. Peripheral thromboembolism contributes significantly to the observed morbidity and mortality. Symptomatic AF, before cardioversion to normal sinus rhythm, requires either exclusion of atrial thrombi using transesophageal echocardiography (TEE) or the conventional use of three weeks of adequate anticoagulation. The exclusion of atrial thrombi by TEE, a nontomographic technique but comparable with conventional treatment of AF in outcomes, has inherent limitations due to the complex three-dimensional multilobed anatomy of the left atrial appendage, where the majority of atrial thrombi arise. Also, the conventional treatment of three weeks of therapeutic anticoagulation before cardioversion reportedly does not always eliminate atrial thrombi. Plasma D-dimer constitutes an antigen-antibody reaction to the dimeric final degradation product of a mature clot. An elevated fibrin D-dimer has a high sensitivity for intravascular thrombosis and, hence, may improve the evaluation of a patient with AF before cardioversion in addition to a TEE. A case is presented in which a positive D-dimer resulted in performing TEE to document atrial thrombosis and the complications of previous bacterial endocarditis. In the present case, this involved aortic root abscess formation and acute aortic regurgitation because of flailing of the noncoronary cusp that resulted in recurrent pulmonary edema.

La fibrillation auriculaire (FA) est une arythmie courante en pratique clinique. Elle touche plus de 4 % de la population de plus de 60 ans. Une thromboembolie périphérique contribue de manière significative à la morbidité et à la mortalité observées. La FA symptomatique, avant cardioversion à un rythme sinusal normal, exige soit l’exclusion des thrombi auriculaires au moyen d’une échocardiographie transœsphagienne (ETO), soit le recours classique à une anticoagulation pertinente pendant trois semaines. L’exclusion des thrombi auriculaires par ETO, une technique non tomographique dont les issues sont comparables à celles du traitement classique de la FA, comporte des limites imputables à l’anatomie multilobe tridimensionnelle de l’appendice auriculaire gauche, où se produisent la majorité des thrombi auriculaires. De plus, l’anticoagulation thérapeutique classique de trois semaines avant la cardioversion n’éliminerait pas toujours les thrombi auriculaires. Le D-dimère dans le plasma est une réaction antigèneanticorps au produit de dégradation finale de D-dimère d’un caillot mature. La fibrine élevée du D-dimère est très sensible à la thrombose intravasculaire, ce qui peut améliorer l’évaluation d’un patient souffrant de FA avant cardioversion, en plus de l’ETO. Un cas est présenté selon lequel un D-dimère positif a donné lieu à une ETO pour documenter la thrombose auriculaire et les complications d’une endocardite bactérienne antérieure. Cet événement avait provoqué la formation d’un abcès de l’anneau aortique et une régurgitation aortique aiguë en raison du volet costal de la valvule non coronarienne responsable de l’œdème pulmonaire récurrent.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Anteroposterior chest x-ray showing perihilar interstitial pulmonary edema two days after discharge from the coronary care unit
Figure 2
Figure 2
Transesophageal echocardiography showing left atrial appendage clot (arrow)
Figure 3
Figure 3
Thickened aortic leaflets with flailing of noncoronary cusp (open arrow) and cavity of aortic root abscess (closed arrow)
Figure 4
Figure 4
Thickened aortic leaflets with flailing noncoronary cusp (open arrow) and aortic root abscess (closed arrow)
See this image and copyright information in PMC

References

    1. Halperin JL, Hart RG. Atrial fibrillation and stroke: New ideas, persisting dilemmas. Stroke. 1988;19:937–41. - PubMed
    1. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: The Framingham study. N Engl J Med. 1982;306:1018–22. - PubMed
    1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: A major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987;147:1561–4. - PubMed
    1. Odell JA, Blackshear JL, Davies E, et al. Thoracoscopic obliteration of the left atrial appendage: Potential for stroke reduction? Ann Thorac Surg. 1996;61:565–9. - PubMed
    1. Klein AL, Grimm RA, Murray RD, et al. Assessment of Cardioversion Using Transesophageal Echocardiography Investigators Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001;344:1411–20. - PubMed

Publication types