D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery

• Published in: British journal of surgery 2004-08, Vol.91 (8), p.991-994
• Main Authors: Acosta, S., Nilsson, T. K., Björck, M.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Aged; Aged, 80 and over; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Fibrin Fibrinogen Degradation Products - analysis; General aspects; Humans; Male; Medical sciences; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion - diagnosis; Middle Aged; Sensitivity and Specificity; Thromboembolism - diagnosis
• ISSN: 0007-1323; 1365-2168; 1365-2168
• DOI: 10.1002/bjs.4645

Background: There is no accurate non‐invasive method available for the diagnosis of acute thromboembolic occlusion of the superior mesenteric artery (SMA). The aim of this study was to assess the diagnostic properties of the fibrinolytic marker D‐dimer. Methods: From September 2000 to April 2003 consecutive patients aged over 50 years admitted to hospital with acute abdominal pain were studied. Patients with possible acute SMA occlusion at presentation had blood samples taken within 24 h of the onset of the pain for analysis of D‐dimer, plasma fibrinogen, activated partial thromboplastin time, prothrombin time and antithrombin. The value of D‐dimer testing to diagnose SMA occlusion was assessed by means of likelihood ratios. Results: Nine of 101 patients included had acute SMA occlusion. The median D‐dimer concentration was 1·6 (range 0·4–5·6) mg/l, which was higher than that in 25 patients with inflammatory disease (P = 0·007) or in 14 patients with intestinal obstruction (P = 0·005). The combination of a D‐dimer level greater than 1·5 mg/l, atrial fibrillation and female sex resulted in a likelihood ratio for acute SMA occlusion of 17·5, whereas no patient with a D‐dimer concentration of 0·3 mg/l or less had acute SMA occlusion. Conclusion: D‐dimer testing may be useful for the exclusion of patients with suspected acute SMA occlusion. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Can exclude the condition