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D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale

Authors
 Y. D. Kim  ;  D. Song  ;  H. S. Nam  ;  K. Lee  ;  J. Yoo  ;  G.-R. Hong  ;  H. S. Lee  ;  C. M. Nam  ;  J. H. Heo 
Citation
 Thrombosis and Haemostasis, Vol.114(3) : 614-622, 2015 
Journal Title
 Thrombosis and Haemostasis 
ISSN
 0340-6245 
Issue Date
2015
Abstract
Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648-17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141065
DOI
10.1160/TH14-12-1040
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
김영대(Kim, Young Dae) ; 남정모(Nam, Jung Mo) ; 남효석(Nam, Hyo Suk) ; 송동범(Song, Dong Beom) ; 유준상(Yoo, Joon Sang) ; 이기정(Lee, Ki Jeong) ; 이혜선(Lee, Hye Sun) ; 허지회(Heo, Ji Hoe) ; 홍그루(Hong, Geu Ru)
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http://th.schattauer.de/en/contents/archive/issue/2249/manuscript/24386.html
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