期刊
JOURNAL OF THE NEUROLOGICAL SCIENCES
卷 285, 期 1-2, 页码 185-190出版社
ELSEVIER
DOI: 10.1016/j.jns.2009.06.032
关键词
D-dimer; Stroke; Stroke etiology; Oxfordshire Community Stroke Project; classification; VIDAS; Triage Stroke Panel
资金
- Institute Born-Bunge
- Belgian Federal Science Policy Office, Belgium
- Medical Research Foundation Antwerp
Background and purpose: Both from clinical and research standpoints, it may be highly relevant to differentiate between small-artery and large-artery infarction in the acute phase of ischemic stroke. We conducted a study on the added value of two D-dimer assays over clinical assessment for diagnosis of lacunar infarction. Methods: Clinical evaluation using the Oxfordshire Community Stroke Project (OCSP) classification and measurement of plasma D-dimer levels by the VIDAS D-dimer test (VIDAS) and the Triage Stroke Panel (TSP) were performed in 128 patients with ischemic stroke presenting within 9 h after onset of symptoms. The stroke subtype was defined as small-artery or large-artery infarction based on the TOAST classification. Results: The overall accuracy for diagnosing of acute lacunar stroke using the OCSP classification, VIDAS (cut point for D-dimer 445 ng/mL) or TSP (cut point 300 ng/mL) was 89%, 88% and 87% respectively (P<0.001). The conjunctive use of the OCSP classification and VIDAS or TSP improved the accuracy to 97% and 98% respectively (P<0.001). The kappa coefficient for agreement between the two assays was acceptable (kappa, 0.64). These results were reproducible in subgroups of patients presenting within 4.5 h and within 6 h after onset of stroke symptoms. Conclusions: Diagnosis of acute lacunar infarction can reliably be made, based on the conjunctive use of clinical evaluation and measurement of D-dimer levels either by a standard assay or by a bedside testing kit, (c) 2009 Elsevier B.V. All rights reserved.
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