Dr. Erika Kancler
Introduction: Acute aortic dissection (AAD) is an emergent, relatively uncommon condition that typically presents with sudden onset severe chest or back pain.1 Advanced imaging, such as computerized tomography, is currently the gold standard to diagnose AAD; this can be expensive and unavailable at all health care centers. D-dimer is a blood test that has been shown in recent studies to be elevated in acute aortic dissection. This may be a more cost-effective way to help the clinician “rule-out” an acute aortic dissection.1
Objective: The purpose of this research was to determine if there is significant data regarding the sensitivity and specificity of a D-dimer in the use of diagnosing an acute aortic dissection.
Methods: A PubMed search was conducted utilizing the following terms and filters: “aortic dissection” and “D-dimer.” Articles were screened and assessed for eligibility based on sample size, evaluation of sensitivity and specificity of d-dimer, and if D-dimer was the only independent factor being examined in diagnosis of an AAD.
Results: Our search resulted in one retrospective observational study, one prospective observational study, and one meta-analysis.
Conclusion: In a patient presenting to the Emergency Department with symptoms suspicious of an acute aortic dissection, a D-dimer level less than 500ng/ml may be a useful tool to decrease the likelihood of the disease and reduce the need for advanced imaging. The D-dimer is not shown to be specific for acute aortic dissection. The addition of a D-dimer as a first line test may be a quick tool to help a clinician adjust their differential diagnoses to determine the need for imaging.1
Scarboro HK, Starkey JB. Application of D-dimer to Aid in Diagnosis of Acute Aortic Dissection. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/25/. Published May 15, 2017.