UMEM Educational Pearls

Category: Vascular

Title: Does a Normal D-Dimer rule out Aortic Dissection?

Keywords: Aortic Dissection, D-Dimer (PubMed Search)

Posted: 6/24/2008 by Rob Rogers, MD (Emailed: 6/30/2008) (Updated: 12/9/2019)
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Does a normal d-dimer rule out aortic dissection?

A lot of research seems to be focused on using d-dimer as a rule-out strategy for acute aortic dissection. The idea is that a d-dimer <500 (which is what we use for ruling out PE in low-mod risk patients) rules out dissection as well.

A few pearls and pitfalls regarding this:

  • Studies look very promising, but NO accepted cutoff point (d-dimer) has been defined
  • This practice has NOT been widely accepted yet
  • A d-dimer <100 ng/dL rules out aortic dissection with a sensitivity of 100%
  • A d-dimer of <500 ng/dL rules out aortic dissection with a sensitivity of 98%
  • Experts in this area seem to be advocating this as a potential rule out strategy
  • Critics of this approach point out the fact that a subset of patients with dissection (those with intramural hematomas-i.e. no intimal tear) may not release d-dimer into the circulation. But almost all studies include patients with this variant and their d-dimers are almost always elevated.

References

Sodeck, Eur Heart J 2007