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. 2022 Nov 22:18:2737-2745.
doi: 10.2147/NDT.S389469. eCollection 2022.

Post-Thrombolytic D-Dimer Elevation Predicts Symptomatic Intracranial Hemorrhage and Poor Functional Outcome After Intravenous Thrombolysis in Acute Ischemic Stroke Patients

Tianyu Jin #  1 , Danyu Chen #  2 , Zhicai Chen  3 , Dujin Feng  4 , Manqi Zheng  5 , Peng Wang  6 , Chao Xu  6
Affiliations

Post-Thrombolytic D-Dimer Elevation Predicts Symptomatic Intracranial Hemorrhage and Poor Functional Outcome After Intravenous Thrombolysis in Acute Ischemic Stroke Patients

Tianyu Jin et al. Neuropsychiatr Dis Treat. .

Abstract

Background: We aimed to investigate the association of post-thrombolytic D-dimer elevation with symptomatic intracranial hemorrhage (sICH) and functional outcome in AIS patients receiving intravenous thrombolysis.

Methods: We retrospectively reviewed our database for patients with AIS who received intravenous thrombolysis between August 2018 and December 2021. ΔD-dimer was calculated as follow-up D-dimer minus baseline D-dimer. Poor functional outcome was defined as 3 months modified Rankin score (mRS) 3-6. sICH was defined as cerebral hemorrhagic transformation in combination with clinical deterioration of National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 24 hours. Binary logistic regression analysis was used to investigate the association of post-thrombolytic D-dimer parameters with sICH and poor functional outcome. The receiver operating characteristic (ROC) curve derived optimal cut-off of different D-dimer parameters was determined at the maximal Youden's Index.

Results: A total of 325 patients were finally included. After controlling for clinical variables, follow-up D-dimer level (OR 1.230; 95% CI 1.119 to 1.351; P < 0.001) and ΔD-dimer (OR 1.347; 95% CI 1.165 to 1.559; P < 0.001) were independently associated with poor functional outcome. Additionally, follow-up D-dimer level (OR 1.095; 95% CI 1.009 to 1.188; P = 0.030) was independently related to sICH. The optimal cut-off value of follow-up D-dimer level for predicting sICH was 4185 μg/L (area under the curve 0.760; sensitivity 76.0%; specificity 81.3%); and the optimal cut-off value of follow-up D-dimer level and ΔD-dimer as a predictor for poor functional outcome was projected to be 3838 μg/L and 2190 μg/L, which yielded a sensitivity and a specificity of 62.3%, 84.5% and 73.8%, 85.2%, respectively.

Conclusion: Elevated follow-up D-dimer levels are associated with sICH and poor functional outcome in AIS patients following intravenous rt-PA. Moreover, post-thrombolytic D-dimer elevation, measured by ΔD-dimer, was a better predictive biomarker for long-term outcome at 3 months.

Keywords: D-dimer; acute ischemic stroke; hemorrhagic transformation; intravenous thrombolysis; outcome.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The ROC curves of follow-up D-dimer level and ΔD-dimer in predicting sICH and poor functional outcome.
See this image and copyright information in PMC

References

    1. Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50:3331–3332. doi:10.1161/STROKEAHA.119.027708 - DOI - PubMed
    1. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European cooperative acute stroke study (ecass). JAMA. 1995;274:1017–1025. - PubMed
    1. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ecass ii). Second European-Australasian acute stroke study investigators. Lancet. 1998;352:1245–1251. doi:10.1016/S0140-6736(98)08020-9 - DOI - PubMed
    1. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (sits-most): an observational study. Lancet. 2007;369:275–282. doi:10.1016/S0140-6736(07)60149-4 - DOI - PubMed
    1. Lansberg MG, Albers GW, Wijman CA. Symptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: a review of the risk factors. Cerebrovasc Dis. 2007;24:1–10. doi:10.1159/000103110 - DOI - PubMed

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