D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke
Por:
Ramos-Pachon, A, Lopez-Cancio, E, Bustamante, A, de la Ossa, NP, Millan, M, Hernandez-Perez, M, Garcia-Berrocoso, T, Cardona, P, Rubiera, M, Serena, J, Ustrell, X, Garces, M, Terceno, M, Davalos, A, Montaner, J
Publicada:
1 mar 2021
Resumen:
Background and Purpose:
Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment.
Methods:
The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels.
Results:
One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31-1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone.
Conclusions:
Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
Filiaciones:
Ramos-Pachon, A:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Lopez-Cancio, E:
Hosp Univ Cent Asturias, Neurol Dept, Oviedo, Spain
Bustamante, A:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
de la Ossa, NP:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Millan, M:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Hernandez-Perez, M:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Garcia-Berrocoso, T:
Univ Autonoma Barcelona, Vall Hebron Inst Recerca VHIR, Neurovasc Res Lab, Barcelona, Spain
Cardona, P:
Hosp Univ Bellvitge, Neurol Dept, Lhospitalet De Llobregat, Spain
Rubiera, M:
Hosp Univ Vall Hebron VHIR, Neurol Dept, Barcelona, Spain
Serena, J:
Hosp Univ Josep Trueta, Neurol Dept, Girona, Spain
Ustrell, X:
Hosp Univ Joan XXIII, Neurol Dept, Tarragona, Spain
Garces, M:
Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Terceno, M:
Hosp Univ Josep Trueta, Neurol Dept, Girona, Spain
Davalos, A:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Montaner, J:
Hosp Badalona Germans Trias & Pujol, Neurosci Dept, Badalona, Spain
Univ Autonoma Barcelona, Vall Hebron Inst Recerca VHIR, Neurovasc Res Lab, Barcelona, Spain
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