Background The D-dimer test has a diagnostic role in pulmonary embolism (PE) ‘ and deep vein thrombosis(DVT). In a low-risk patient with negative D-dimer, PE or DVT can safely be ruled out.^{1 2} We aim to know whether the D-dimer has a similar role in cerebral vein thrombosis (CVT) diagnosis.

Methods/Design We attempt to identify studies that assess D-dimer’s diagnostic accuracy and reporting its sensitivity and specificity in CVT diagnosis. A literature review was performed in PubMed from 1996 to July 2021, Google scholar, and BestBETs electronic resources. The AMSTAR tool was used to assess the quality of included studies.

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Abstract 981 Figure 1

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Results/Conclusions Out of 66 non-duplicated citations, 15 articles were relevant to our clinical question. Eight articles were included in one of the retrieved meta-analyses, and four articles were excluded during data collection because of unclear results. Two systematic reviews & meta-analyses^{3 4} and one cohort study⁵ were included for the systematic review. The selection process is shown in figure (1). The studies are tabled with details of author, publication date, population details, and results as in table (1). Most studies show D–dimer has a high sensitivity, around 93 to 97%, in CVT diagnosis. However, its sensitivity is affected by age, thrombus sizes, and the method used in the D-dimer assay.

A review shows that more CVT extension & earlier presentation (<2weeks) were correlated with higher D-dime levels. Unfortunately, most of the studies are not high-quality studies, with variable designs, population, and reference standard tests. The studies showed that D dimer could help predict CVT in combination with risk factors and clinical presentation.

We concluded that the normal D-dimer only should not be used to exclude CVT. There is a probability of using D-dimer in CVT risk scoring and pre-imaging negotiation, and for that purpose, larger and higher-quality studies are needed.

References

1. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005 Apr 28;352(17):1791–8. doi:10.1056/NEJMra042354. PMID: 15858188.

2. Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med 2010 Jul 15;363(3):266–74. doi:10.1056/NEJMra0907731. Epub 2010 Jun 30. PMID: 20592294.

3. Dentali F, Squizzato A, Marchesi C, Bonzini M, Ferro JM, Ageno W. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost 2012 Apr;10(4):582–9. doi:10.1111/j.1538-7836.2012.04637.x. PMID: 22257124.

4. Alons IM, Jellema K, Wermer MJ, Algra A. D-dimer for the exclusion of cerebral venous thrombosis: a meta-analysis of low risk patients with isolated headache. BMC Neurol 2015 Jul 28;15:118. doi:10.1186/s12883-015-0389-y. PMID: 26215857; PMCID: PMC4517419.

5. Thammishetti V, Dharanipragada S, Basu D, Ananthakrishnan R, Surendiran D. A prospective study of the clinical profile, outcome and evaluation of d-dimer in cerebral venous thrombosis. J Clin Diagn Res 2016 Jun;10(6):OC07–10. doi:10.7860/JCDR/2016/19114.7926. Epub 2016 Jun 1. PMID: 27504325; PMCID: PMC4963685.