d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source

• Published in: Stroke (1970) 2021-07, Vol.52 (7), p.2292-2301
• Main Authors: Choi, Kang-Ho, Kim, Ja-Hae, Kim, Jae-Myung, Kang, Kyung-Wook, Lee, Changho, Kim, Joon-Tae, Choi, Seong-Min, Park, Man-Seok, Cho, Ki-Hyun
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Cohort Studies; Embolic Stroke - blood; Embolic Stroke - diagnostic imaging; Female; Fibrin Fibrinogen Degradation Products - metabolism; Follow-Up Studies; Humans; Male; Middle Aged; Predictive Value of Tests; Recurrence; Retrospective Studies
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.120.033217

This study aimed to investigate the value of d-dimer levels in predicting recurrent stroke in patients with embolic stroke of undetermined source. We also evaluated the underlying causes of recurrent stroke according to d-dimer levels. A total of 1431 patients with undetermined source were enrolled in this study and divided into quartiles according to their baseline plasma d-dimer levels. The primary outcome measure was the occurrence of recurrent stroke (ischemic or hemorrhagic) in the year following the stroke event. The risk of recurrent stroke increased significantly with the increasing d-dimer quartile (log-rank P=0.001). Patients in the higher d-dimer quartiles had a higher probability of recurrent embolic stroke because of covert atrial fibrillation, hidden malignancy, or undetermined sources. Most recurrent strokes in Q3 and Q4 were embolic but not in Q1 or Q2. Multivariate analysis revealed that patients in Q3 and Q4 had a significantly increased risk of recurrent stroke compared with those in Q1 (hazard ratio, 3.12 [95% CI, 1.07−9.07], P=0.036; hazard ratio, 7.29 [95% CI, 2.59−20.52], P