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Hacialioglu RA, Kielkopf M, Branca M, Clenin L, Boronylo A, Silimon N, Göldlin MB, Scutelnic A, Kaesmacher J, Mujanovic A, Meinel TR, Seiffge DJ, Heldner MR, Liberman AL, Navi BB, Fischer U, Arnold M, Jung S, Bücke P, Beyeler M. Factors impacting D-dimer levels in patients with acute ischemic cerebrovascular events. J Stroke Cerebrovasc Dis 2024; 33:107834. [PMID: 38936311 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107834] [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: 04/12/2024] [Revised: 06/12/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A better understanding of the factors influencing D-dimer levels in code stroke patients is needed to guide further investigations of concomitant thrombotic conditions. This study aimed to investigate the impact of time from symptom onset and other factors on D-dimer levels in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). METHODS Data on consecutive AIS and TIA patients treated at our tertiary-care stroke center between January 2015 and December 2020 were retrospectively assessed. Patients with available D-dimer levels were evaluated for eligibility. Multivariable non-linear regression analyses were performed. RESULTS In total, 2467 AIS patients and 708 TIA patients were included. The median D-dimer levels differed between the AIS and TIA groups (746 µg/L [interquartile range 381-1468] versus 442 µg/L [interquartile range 244-800], p<0.001). In AIS patients, an early increase in D-dimer levels was demonstrated within the first 6 h (standardized beta coefficient [β] 0.728; 95% confidence interval [CI] 0.324-1.121). This was followed by an immediate decrease (β -13.022; 95% CI -20.401 to -5.643) and then by a second, late increase after 35 h (β 11.750; 95% CI 4.71-18.791). No time-dependent fluctuation in D-dimer levels was observed in TIA patients. CONCLUSION The time from symptom onset may affect D-dimer levels in patients with AIS but not those with TIA. Further studies confirming these findings and validating time-specific variations are needed to enable D-dimer levels to be used efficiently as an acute stroke and thrombotic risk biomarker.
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Affiliation(s)
- Recep-Ali Hacialioglu
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Moritz Kielkopf
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mattia Branca
- CTU Bern, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leander Clenin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Anna Boronylo
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martina B Göldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Graduate School for Health Sciences, University of Bern, Switzerland.
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DiPaola E, Cameron S, Rylander H, Zidan N, Hetzel S. Comparison of D-dimer concentration and thromboelastography for diagnosis of cerebrovascular accidents in dogs: A retrospective study. J Vet Intern Med 2024; 38:1083-1091. [PMID: 38328940 PMCID: PMC10937503 DOI: 10.1111/jvim.17000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Cerebrovascular accidents (CVAs) in dogs are diagnosed using magnetic resonance imaging (MRI). This modality is sometimes unavailable, and CVAs can resemble other lesions on MRI. D-dimer concentration and thromboelastography (TEG) are utilized in human medicine in addition to diagnostic imaging to support diagnosis of CVAs, but their use in veterinary patients has not been assessed. OBJECTIVE Assess utility of blood D-dimer concentration and TEG in supporting the imaging diagnosis of CVAs in dogs. ANIMALS Sixty-eight client-owned dogs with neurologic signs that had brain MRI and D-dimer concentration or TEG performed. METHODS Multicenter, retrospective study. The incidence of abnormal D-dimer concentration or TEG was compared between patients with MRI evidence of CVA and a control population. Analysis methods included Fisher's exact test or Chi-squared test for association and comparison of independent proportions. RESULTS Neither D-dimer concentration nor TEG was significantly associated with a CVA (P = .38 and .2, respectively). D-dimer testing was performed in a low-risk population and showed low sensitivity (30.8%; 95% confidence interval [CI], 10%-61%) and high specificity (86.4%; 95% CI, 64%-96%) for CVA diagnosis. Thromboelastography was performed in a high-risk population and showed moderate sensitivity (64.3%; 95% CI, 44%-81%) and specificity (66.7%; 95% CI, 24%-94%) for CVA diagnosis. Abnormal D-dimer concentration or TEG were not helpful in differentiating hemorrhagic from ischemic stroke (P = .43 and .41, respectively). CONCLUSIONS Although blood D-dimer concentration or TEG alone are not diagnostic of CVAs in dogs, a positive D-dimer result supports additional testing for CVA.
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Affiliation(s)
- Elizabeth DiPaola
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Starr Cameron
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Helena Rylander
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Natalia Zidan
- Department of Medical SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Scott Hetzel
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Barakzie A, Jansen AG, ten Cate H, de Maat MP. Coagulation biomarkers for ischemic stroke. Res Pract Thromb Haemost 2023; 7:100160. [PMID: 37274178 PMCID: PMC10236221 DOI: 10.1016/j.rpth.2023.100160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 06/06/2023] Open
Abstract
A State of the Art lecture titled "coagulation biomarkers for ischemic stroke" was presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in 2022. Ischemic stroke (IS) is a common disease with major morbidity and mortality. It is a challenge to determine which patients are at risk for IS or have poor clinical outcome after IS. An imbalance of coagulation markers may contribute to the progression and prognosis of IS. Therefore, we now discuss studies on the association of selected coagulation biomarkers from the hemostasis, inflammation, and immunothrombosis systems with the risk of IS, stroke severity at the acute phase, and clinical outcome after treatment. We report on coagulation biomarker-induced risk of IS, stroke severity, and outcomes following IS derived from prospective population studies, case-control studies, and acute-phase IS studies. We found indications that many coagulation and inflammation biomarkers are associated with IS, but it is early to conclude that any of these biomarkers can be applied in a therapeutic setting to predict patients at risk of IS, stroke severity at the acute phase, and clinical outcome after treatment. The strongest evidence for a role in IS was found for beta-thromboglobulin, von Willebrand factor, factor VIII, fibrinogen, thrombin-activatable fibrinolysis inhibitor, D-dimer, and neutrophil extracellular traps, and therefore, they are promising candidates. Further research and validation in large-size populations using well-defined study designs are warranted. Finally, we provide a selection of recent data relevant to this subject that was presented at the 2022 ISTH Congress.
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Affiliation(s)
- Aarazo Barakzie
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A.J. Gerard Jansen
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hugo ten Cate
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands
- Thrombosis Expertise Center and Department of Internal Medicine, Maastricht University Medical Centre, The Netherlands
| | - Moniek P.M. de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Feng L, He Y, Dong S, Wang R, Long S, He L. An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy. Contemp Nurse 2022; 58:264-275. [PMID: 36052463 DOI: 10.1080/10376178.2022.2107038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT). METHODS We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0). RESULTS At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2%(n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n =70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p<0.001), indwelling urinary catheter (p<0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p<0.001) and Activities of Daily Living (ADL) score (p<0.001) at the time of discharge from hospital. The average hospitalisation time of the 144 patients was 12[IQR, 9-25] days, and the average cost of hospitalisation was $Y$21291.93 (SD 9165.01). CONCLUSION Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome. IMPACT STATEMENT We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.
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Affiliation(s)
- Ling Feng
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Yueyue He
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
| | - Rui Wang
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shiyan Long
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
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