You Li-Rui, Tang Mei
Department of Geriatric, Medical Care Centre, Beijing Friendship Hospital, Captial Medical University.
Department of Internal Medicine, Beijing Norther Hospital, Beijing, China.
Medicine (Baltimore). 2018 Oct;97(43):e12622. doi: 10.1097/MD.0000000000012622.
This study aimed to explore the relationship of D-dimer level with the risk stratification of ischemic stroke, and determine whether high D-dimer levels could be used as a risk factor of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF).This single-center, retrospective study recruited NVAF patients who did not undergo anticoagulant therapy. These patients were divided into 2 groups: ischemic stroke group and no-stroke group. The medical records of each patient were reviewed, demographic and clinical analyses were performed, and the laboratory results were summarized.A total of 323 eligible in-patients with NVAF, who did not receive anticoagulant therapy, were recruited (206 male and 117 female patients, median age was 75.18 ± 10.46 years old). Among these patients, 78 patients suffered from acute ischemic stroke. D-dimer level increased with age, and was positively correlated with the risk stratification of stroke, CHADS2 score (rs = 0.441, P < .001), and CHA2DS2-VASC score (rs = 0.412, P < .001), even after adjustment for age and gender (rs = 0.422, P < .001). The difference in baseline D-dimer level between these 2 groups was not statistically significant (0.70 vs 0.66 mg/L, P = .330), but this significantly increased when patients suffered from stroke (1.34 vs 0.70 mg/L, P < .001). The D-dimer level after stroke (≥6 months) was also higher than the baseline (1.16 vs 0.68 mg/L, P = .514) in 6 months, and this level nearly returned to baseline level after one year (0.69 vs 0.68 mg/L, P = .158). However, logistic regression revealed that only the D-dimer level at stroke onset and OMI were independent risk factors for ischemic stroke (P < .001), while the increase from baseline D-dimer levels was not an independent risk factor (P = .125).D-dimer level is positively correlated with the risk stratification of ischemic stroke, but has no predictive value on the occurrence of ischemic stroke in patients with NVAF.
本研究旨在探讨D-二聚体水平与缺血性卒中风险分层的关系，并确定高D-二聚体水平是否可作为非瓣膜性心房颤动（NVAF）患者缺血性卒中的危险因素。这项单中心回顾性研究纳入了未接受抗凝治疗的NVAF患者。这些患者被分为两组：缺血性卒中组和无卒中组。回顾了每位患者的病历，进行了人口统计学和临床分析，并总结了实验室结果。
共纳入323例未接受抗凝治疗的符合条件的NVAF住院患者（男性206例，女性117例，中位年龄为75.18±10.46岁）。其中，78例患者发生急性缺血性卒中。D-二聚体水平随年龄增加而升高，与卒中风险分层、CHADS2评分（rs = 0.441，P <.001）和CHA2DS2-VASC评分（rs = 0.412，P <.001）呈正相关，即使在调整年龄和性别后（rs = 0.422，P <.001）。这两组患者的基线D-二聚体水平差异无统计学意义（0.70 vs 0.66 mg/L，P =.330），但在患者发生卒中时显著升高（1.34 vs 0.70 mg/L，P <.001）。卒中后（≥6个月）的D-二聚体水平在6个月时也高于基线水平（1.16 vs 0.68 mg/L，P =.514），而在1年后该水平几乎恢复到基线水平（0.69 vs 0.68 mg/L，P =.158）。然而，逻辑回归显示，只有卒中发作时的D-二聚体水平和OMI是缺血性卒中的独立危险因素（P <.001），而基线D-二聚体水平的升高不是独立危险因素（P =.125）。
D-二聚体水平与缺血性卒中风险分层呈正相关，但对NVAF患者缺血性卒中的发生没有预测价值。
