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Prognostic Value of Serum D-Dimer in Noncardioembolic Ischemic Stroke

  • Tae-Won Kim (a1), In-Uk Song (a1) and Sung-Woo Chung (a1)
Abstract

Background: Although D-dimer levels are significantly associated with cardioembolic infarction, the significance of D-dimer levels in relation to the severity and functional outcomes of other stroke subtypes, such as lacunar and large artery atherosclerosis infarction, remains unclear. The purpose of this study was to evaluate whether elevated initial D-dimer levels are significantly and cross-sectionally associated with poor functional outcomes at each time point during a 9-month follow-up period. We also investigated the significance of D-dimer levels in longitudinal temporal changes of functional outcomes in these patients. Methods: We recruited 146 patients with lacunar infarction and 161 patients with large artery atherosclerosis infarction who were consecutively admitted to our hospital after acute stroke. Serum D-dimer levels were evaluated initially and the modified Rankin scale were measured initially and at 1-, 3-, 6-, and 9-month follow-up visits. Results: Patients with higher D-dimer levels had significantly worse initial functional outcomes, and these worse outcomes were maintained throughout the 9-month follow-up period compared with the low D-dimer group. However, regardless of stroke subtype, D-dimer levels did not influence long-term changes in functional outcomes over the 9-month follow-up period. Conclusion: This study suggests that elevated D-dimer levels can be used as a surrogate marker for poor functional outcomes only during the acute stage. Further evaluation of serum D-dimer levels could provide a helpful predictive marker for stroke prognosis.

Valeur pronostique de la concentration de D-dimères dans le cas d’AVC ischémiques non cardio-emboliques. Contexte: Bien qu’une concentration élevée de D-dimères (DD) soit associée de façon significative à des infarctus d’origine cardio-embolique, l’importance de ces DD en rapport avec la gravité et les conséquences fonctionnelles d’autres types d’AVC, par exemple les infarctus lacunaires et ceux attribuables à l’athérosclérose d’une artère importante, demeurent floues. L’objectif de cette étude a donc été d’évaluer dans quelle mesure des concentrations élevées de DD étaient initialement associées de façon significative et transversalement à de sévères conséquences fonctionnelles au cours d’une période de suivi de 9 mois. Nous avons aussi exploré l’importance des concentrations de DD en lien avec les changements temporels affectant nos patients et les conséquences fonctionnelles de leur AVC. Méthodes: Nous avons recruté 146 patients victimes d’un infarctus lacunaire ainsi que 161 autres ayant été victimes d’un infarctus attribuable à l’athérosclérose d’une artère et hospitalisés à la suite d’un AVC aigu. Dans un premier temps, leurs concentrations de DD ont été mesurées. Nous avons ensuite évalué ces mêmes patients une première fois en fonction de l’échelle modifiée de Rankin et lors de leurs visites de suivi (1, 3, 6 et 9 mois). Résultats: Les patients dont la concentration de DD était plus élevée ont initialement montré de sévères conséquences fonctionnelles. Ces conséquences plus sévères n’ont pas varié tout au long de la période de suivi de 9 mois si on les compare à celles du groupe dont la concentration de DD était faible. À long terme toutefois, la concentration de DD n’a pas eu d’impact sur les changements aux conséquences fonctionnelles au cours de la période de suivi de 9 mois, et ce, quels que soient les sous-types d’AVC. Conclusions: En somme, cette étude suggère qu’une concentration élevée de DD ne peut être utilisée comme marqueur de substitution prédictif de sévères conséquences fonctionnelles que durant la phase aiguë d’un épisode. Cela dit, une étude plus approfondie de la concentration de DD pourrait aboutir à l’apparition d’un marqueur prédictif utile dans les cas de pronostics post-AVC.

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Copyright
Corresponding author
Correspondence to: In-Uk Song, Department of Neurology, College of Medicine, Incheon St Mary’s Hospital, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 403-720, South Korea. E-mail: siuy@catholic.ac.kr.
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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