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

 Y. D. Kim  ;  D. Song  ;  H. S. Nam  ;  K. Lee  ;  J. Yoo  ;  G.-R. Hong  ;  H. S. Lee  ;  C. M. Nam  ;  J. H. Heo 
 THROMBOSIS AND HAEMOSTASIS, Vol.114(3) : 614-622, 2015 
Journal Title
Issue Date
Aged ; Biomarkers/blood ; Brain Ischemia/blood* ; Brain Ischemia/diagnosis ; Brain Ischemia/etiology ; Brain Ischemia/mortality ; Cause of Death ; Chi-Square Distribution ; Echocardiography, Transesophageal ; Embolism, Paradoxical/blood* ; Embolism, Paradoxical/diagnosis ; Embolism, Paradoxical/etiology ; Embolism, Paradoxical/mortality ; Female ; Fibrin Fibrinogen Degradation Products/analysis* ; Foramen Ovale, Patent/blood* ; Foramen Ovale, Patent/complications ; Foramen Ovale, Patent/diagnosis ; Foramen Ovale, Patent/mortality ; Humans ; Kaplan-Meier Estimate ; Latex Fixation Tests ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/blood* ; Stroke/diagnosis ; Stroke/etiology ; Stroke/mortality ; Time Factors
Cerebrovascular diseases ; patent foramen ovale ; stroke/prevention ; thrombosis
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.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Jung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Song, Dong Beom(송동범)
Yoo, Joon Sang(유준상)
Lee, Ki Jeong(이기정)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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