D-dimer predicts early clinical progression in ischemic stroke - Confirmation using routine clinical assays

Background and Purpose - Plasma D-dimer levels, measured using a research laboratory assay, independently predict progressing ischemic stroke. We wished to confirm these findings using commercially available assays and to provide data to allow the design of intervention studies. Methods - We studied 219 consecutive acute ischemic stroke admissions of whom 54 (25%) met criteria for progressing stroke. Results - There were strong correlations between D-dimer results as measured by the Biopool AB, MDA and VIDAS assays; correlation coefficients r = 0.91 to 0.94; all P < 0.001. In binary logistic regression analyses, D-dimer, as measured by the 3 different assays, was an independent predictor of progressing stroke ( odds ratios, 1.87 to 2.45; all P < 0.001). This confirms the results of our original analysis ( Biopool AB) using 2 commercial D-dimer assays, demonstrating the potential usefulness of D-dimer in providing early prognostic information after ischemic stroke in different clinical settings. We also provide information on the performance of the 3 assays in predicting progressing stroke at a variety of cutoff values. Conclusions - Ischemic stroke patients at high risk of early progression can be identified using commercial D-dimer measurements. This could allow selection of high-risk patients for inclusion in randomized trials of early antithrombotic treatments.