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D-dimer in Acute Aortic Dissection^*

^* From the Cardiology Department, General Hospital of the Barmherzigen Schwestern, Wels, Austria.

Correspondence to: Thomas Weber, MD, Second Internal Department/Cardiology, General Hospital of the Barmherzigen Schwestern, Grieskirchnerstrasse 42, A-4600 Wels, Austria; e-mail: webertom{at}aon.at

Study objective: Laboratory testing plays a minor role in the assessment of aortic dissection. Its main value is in the exclusion of other diseases. Following an incidental observation, we systematically investigated the relationship between elevated d-dimer levels and acute aortic dissection.

Design: We prospectively tested d-dimer levels in patients with suspected acute aortic dissection (10 patients). In addition, we investigated 14 patients who had received a confirmed diagnosis of thoracic aortic dissection during the previous 5 years, in whom d-dimer testing had been performed for differential diagnosis. Thirty-five patients with acute chest pain of other origin served as a control group.

Setting: Tertiary referral hospital.

Patients: Twelve patients had type A dissection (Stanford classification), and 12 patients had type B.

Measurements and results: A d-dimer analysis was performed (Tina-quant assay; Roche Diagnostics; Mannheim, Germany) [normal limit of the assay, 0.5 µg/mL]. The result of the d-dimer test was positive (ie, > 0.5 µg/mL) in all patients (sensitivity of the test, 100%) with a mean value of 9.4 µg/mL and a range of 0.63 to 54.7 µg/mL. The degree of the elevation was correlated to the delay from the onset of symptoms to laboratory testing (mean, 12.6 h; range, 1 to 120 h) and showed a trend to the extent of the dissection, but not to the outcome (14 patients could be discharged; 10 patients died).

Conclusions: Based on our observation, we suggest that testing for d-dimer should be part of the initial assessment of patients with chest pain, especially if aortic dissection is suspected. A negative test result makes the presence of the disease unlikely.

Key Words: aorta • coagulation • d-dimer • dissection

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