Proposal of a clinical tool to risk-stratify patients in order to improve the sensitivity of D-dimer in ruling-out patients with suspected acute aortic dissection.

摘要

Problem:Acute aortic dissection is a cardiovascular emergency associated with high mortality, especially if not recognized early in its course. While radiologic confirmation is crucial in patients suspected of the disease, it is not without its disadvantages. The serum blood marker, D-dimer, would be a welcomed test to help rule out acute aortic dissection because of its relatively low cost, risk, and time to result. Methods: Peer-reviewed articles within the past five years were identified that analyzed D-dimer and its effectiveness in ruling out acute aortic dissection. An additional two studies of historical importance and frequency of citation were included based on review of the initial query. Results: Of the original empirical studies reviewed, the sensitivity of D-dimer ranged from 82-100% in its ability to rule out acute aortic dissection. There is high variability among the results of the studies; however, false negative rates provide insight into the specific reasons that may account for a lower than expected D-dimer level in acute aortic dissection. Further studies suggest the importance of D-dimer in an algorithm for patients presenting with chest pain to rapidly identify patients in whom thrombolytic or anti-coagulant therapy could be devastating. Conclusions: D-dimer shows potential as an aid to guide clinicians in the management of chest pain, but until more prospective studies are performed, standardization of the D-dimer assays is studied, and validated clinical decision rules are adopted, it is inadvisable to use D-dimer alone to exclude acute aortic dissection.