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Shang X, Li X. D-Dimer and the Short-Term Prognosis of Patients with Subarachnoid Hemorrhage: A Meta-Analysis. Eur Neurol 2024:1-15. [PMID: 38991507 DOI: 10.1159/000540163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Elevated plasma D-dimer has been observed in acute phase of subarachnoid hemorrhage (SAH), while a quantitative evaluation for the association between D-dimer level and prognosis of SAH remains lacking. The aim of the meta-analysis was to investigate the potential predictive role of D-dimer for the short-term functional outcome of patients with SAH. METHODS Relevant observational studies were retrieved by searching PubMed, Web of Science, Embase, Wanfang, and CNKI. A poor functional outcome was generally defined by the Glasgow Outcome Scale (1-3) or the modified Rankin Scale (≥3). A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity. RESULTS Eleven studies involving 3,748 patients with SAH were included. Among them, 1,131 patients (30.2%) developed a poor functional outcome within 6 months. The pooled results showed that a higher plasma D-dimer at admission was associated with a higher risk of poor functional outcome during follow-up (odds ratio per 1 mg/L increment of D-dimer: 1.65, 95% confidence interval: 1.49-1.82, p < 0.001; I2 = 0%). Sensitivity analysis by excluding one study at a time showed similar results. Subgroup analyses suggested that the association between D-dimer and poor functional outcome of patients with SAH was not significantly affected by study design, country, mean age, proportion of men, follow-up duration, methods for defining poor outcome, study quality scores, timing of D-dimer measurement, or the publication year. CONCLUSION A high plasma D-dimer at admission is associated with a poor short-term functional outcome of patients with SAH.
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Affiliation(s)
- Xubin Shang
- Department of Emergency Medicine, Longhua District People's Hospital, Shenzhen, China
| | - Xingmin Li
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
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Gjermeni D, Anfang V, Szabó S, Vetter H, Venhoff AC, Leggewie S, Hesselbarth D, Trenk D, Buechsel M, Westermann D, Olivier CB. D-dimer and fibrinogen indicate ischemic risk in patients with atrial fibrillation after percutaneous coronary intervention. Thromb J 2024; 22:42. [PMID: 38773510 PMCID: PMC11107060 DOI: 10.1186/s12959-024-00610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/16/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the association of antiphospholipid antibodies (aPL) and conventional markers of coagulation with ischemic and bleeding risk in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). METHODS In this prospective two-center observational cohort study, patients with AF and an indication for oral anticoagulation (OAC) were enrolled after PCI. Blood was drawn on day 1-3 after PCI. Dilute Russell's viper venom time was used to determine lupus anticoagulant (LA) in OAC-free plasma. Anti-cardiolipin (aCL) IgG, IgM, and anti-β2-Glycoprotein 1 (aβ2GP1) IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). Fibrinogen (FIB), d-dimer, and prothrombin fragment 1 and 2 (PF 1 + 2) were measured in citrated plasma. The primary ischemic outcome was time to major adverse cardiovascular events (MACE; death, myocardial infarction, or stroke) assessed at 6 months. Bleeding was defined according to International Society on Thrombosis and Haemostasis. RESULTS 158 patients were enrolled between May 2020 and May 2021 on day 1-3 after PCI. The median age was 78 years (interquartile range [IQR] 72-82), 111 (70%) were male, and 39 (25%) presented with acute coronary syndrome. D-dimer was elevated in 74 (47%) patients, FIB was increased in 40 (25%) and PF1 + 2 in 68 (43%) patients. 32 (20%) patients had ≥ 1 antiphospholipid antibody elevated (aPL; LA: 19 [12%], aCL: 14 [9%], aβ2GP1: 2 [1%]). The presence of aPL was neither significantly associated with MACE (HR 1.46, 95% CI [0.39-5.49], p = 0.579), nor bleeding (HR 1.07 [0.30-3.84], p = 0.917). Elevated d-dimer was significantly associated with higher risk for MACE (HR 5.06 [1.09-23.41], p = 0.038) and major bleeding (HR 7.04 [1.58-31.47], p = 0.011). Elevated D-dimer increased the predictive capacity of HAS-BLED for major bleedings (HAS-BLED: AUC 0.71 [0.60-0.83] vs. HAS-BLED + d-dimer: AUC 0.79 [0.70-0.88]; p = 0.025). Increased levels of FIB were associated with higher risk for MACE (HR 3.65 [1.11-11.96], p = 0.033). CONCLUSION Biomarkers of coagulation might be suitable to assess ischemic and bleeding risk in patients with AF following PCI.
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Affiliation(s)
- Diona Gjermeni
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viktoria Anfang
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sofia Szabó
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Vetter
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ana C Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Leggewie
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Hesselbarth
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Buechsel
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph B Olivier
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Rav Acha M, Taha L, Turyan A, Farkash R, Bayya F, Karmi M, Steinmetz Y, Shaheen FF, Perel N, Hamayel K, Levi N, Karameh H, Tvito A, Glikson M, Asher E. D-Dimer as a Prognostic Factor in a Tertiary Center Intensive Coronary Care Unit. Clin Appl Thromb Hemost 2022; 28:10760296221110879. [PMID: 35866208 PMCID: PMC9310202 DOI: 10.1177/10760296221110879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce. MATERIAL AND METHOD All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old). RESULTS AND DISCUSSION A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004). CONCLUSION Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.
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Affiliation(s)
- Moshe Rav Acha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Turyan
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rivka Farkash
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Feras Bayya
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammad Karmi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Fauzi Fadi Shaheen
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kamal Hamayel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Tvito
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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