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Detection of acute thoracic aortic dissection with D-dimer

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Report by Chad VanderLinden, Senior Resident

Checked by Dr Jeffrey Jones and Dr Michael Brown, Research Director and Director of the Emergency Medicine Residency Program, respectively

Abstract

A short cut review was carried out to establish whether a raised D-dimer could be used to identify patients with an acute thoracic aortic dissection. Seven papers were found addressing the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are presented in table 1. The clinical bottom line is that a D-dimer value <500 ng/ml makes the diagnosis unlikely but there is still the possibility of a thrombosed false lumen.

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Table 1

Three part question

In [emergency department patients with chest pain] can [D-Dimer] [detect acute thoracic aortic dissection]?

Clinical scenario

A 71-year-old woman with a history of hypertension presents to the emergency department with a sudden onset of …

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