Role of D-Dimer in Stroke: A Systematic Review

Author(s): Eraky AM, Osula F, Aboaba AO, Rasheed M, Khalid KN, Efobi O, Mashlah A, Ahmed M, Fatima M, Ofudu F, Khan HRA, Ravindran SG, Oreniyi O, Ramzi SHT, Akinfenwa SA

Introduction and Objective: cute cerebral strokes lead to complex chronic disabilities worldwide, bearing high morbidity and mortality. Around 7 in 10 strokes occur in low- and middle-income countries (LMIC). D-dimer is a commonly performed laboratory test that is easily accessible in LMIC. This systematic review aims to evaluate the effectiveness of D-dimer as a diagnostic predictor of stroke within the 6- and 24-hour time period.

Methods: This systematic review adhered to PRISMA guidelines. Keywords including stroke, D-dimer, laboratory testing, and indicators were used. PubMed, Scopus, and CINAHL Plus were searched. Quality appraisal was conducted using the Newcastle Ottawa Scale.

Results: A total of nine studies were included in the review. Studies were conducted in Spain (n=3), Germany (n=1), China (n=1), Turkey (n=1), USA (n=1), Korea (n=1), and Italy (n=1). Statistical significance of D-dimer values was found in 6 of the nine studies (66.6%). The overall quality of evidence is considered to be at the upper-moderate level.

Conclusion: D-dimer is a promising biomarker that may be utilized and fully scaled as a rapid biochemical test to diagnose stroke. As the lab test is already conducted across many healthcare settings, the extension to testing in patients with acute cerebrovascular ischemic events will help predict the exact stroke type and quicken treatment formalities. This systematic review identifies statistically signi-ficant (P<0.05) differences of plasma D-dimer values within 6 and 24 hours among stroke and stroke-mimicking patients. No optimal cut-off value was determined due to the dearth of data. An optimal cut-off value of plasma D-dimer levels must be determined in future clinical studies to estimate the sensitivity and specificity of D-dimer in diagnosing stroke.