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
. 2022 Jul 28:14:367-373.
doi: 10.2147/OAEM.S373335. eCollection 2022.

A Retrospective Analysis of Serum D-Dimer Levels for the Exclusion of Acute Aortic Dissection

Tony Zitek  1 , Mani Hashemi  2 , Sara Zagroba  2 , Valori H Slane  2
Affiliations

A Retrospective Analysis of Serum D-Dimer Levels for the Exclusion of Acute Aortic Dissection

Tony Zitek et al. Open Access Emerg Med. .

Abstract

Purpose: Acute aortic dissection (AAD) is a highly fatal disorder if not promptly diagnosed. Some international studies have suggested that serum d-dimer levels may be used to exclude AAD, but data are limited. We sought to confirm that d-dimer levels are elevated in American patients with AAD. Additionally, we sought to estimate the test characteristics of the d-dimer for AAD.

Patients and methods: We performed a retrospective analysis of patients in the Hospital Corporation of America database who arrived at the hospital between 2015 and 2019. We queried the database to find patients who had a diagnosis of AAD or (nonspecific) chest pain, and who also had a d-dimer performed within 24 hours of arrival at the hospital. The median d-dimer was compared in those diagnosed with AAD versus chest pain. We estimated the test characteristics of d-dimer for AAD at the standard cutoff value of 500 ng/mL.

Results: In total, 48,902 patients met the criteria for analysis, including 572 with AAD and 48,330 with chest pain. The median d-dimers were 2455 ng/mL and 385 ng/mL for the AAD and chest pain groups, respectively (p < 0.0001). Using a cutoff of 500 ng/mL, the sensitivity of the d-dimer was 91.1% and the specificity was 71.4%.

Conclusion: Serum d-dimer values are higher in patients with AAD than in those with nonspecific chest pain. At the standard cutoff of 500 ng/mL, the serum d-dimer has a high sensitivity for AAD, but not high enough that d-dimer levels alone can be used in isolation to exclude AAD.

Keywords: aorta; d-dimer; diagnosis; dissection.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve for d-dimer values and acute aortic dissection.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):1271–1278. doi:10.1378/chest.117.5.1271 - DOI - PubMed
    1. Asha SE, Miers JW. A systematic review and meta-analysis of D-dimer as a rule-out test for suspected acute aortic dissection. Ann Emerg Med. 2015;66(4):368–378. doi:10.1016/j.annemergmed.2015.02.013 - DOI - PubMed
    1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease - a report of the American College of Cardiology Foundation/American Heart Association Task Force On Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266–369. doi:10.1161/CIR.0b013e3181d4739e - DOI - PubMed
    1. Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–2086. doi:10.1001/archinternmed.2009.427 - DOI - PMC - PubMed
    1. Suzuki T, Distante A, Zizza A, et al. Diagnosis of acute aortic dissection by D-Dimer The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009;119(20):2702–2707. - PubMed