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NEUROLOGY 2006;67:94-98
© 2006 American Academy of Neurology

Plasma d-dimer predicts poor outcome after acute intracerebral hemorrhage

P. Delgado, MD, J. Álvarez-Sabín, MD, PhD, S. Abilleira, MD, PhD, E. Santamarina, MD, F. Purroy, MD, PhD, J. F. Arenillas, MD, PhD, C. A. Molina, MD, PhD, I. Fernández-Cadenas, MSc, A. Rosell, PhD and J. Montaner, MD, PhD

From the Neurovascular Research Laboratory and the Stroke Unit, Departament de Medicina, Universitat Autònoma de Barcelona, Hospital General Vall d'Hebron, Barcelona, Spain.

Address correspondence and reprint requests to Dr. P. Delgado Martínez, Unitat Neurovascular (Servei de Neurologia), 9ª planta, Hospital General Vall d'Hebron, Passeig Vall d'Hebrón 119-129, 08035 Barcelona, Spain; e-mail: 35070pdm{at}comb.es

Objective: To investigate if systemic d-dimer activation occurs after acute intracerebral hemorrhage (ICH) and to study its influence on clinical outcome.

Methods: The authors determined plasma baseline d-dimer in 98 consecutive acute (<24 hours) ICH patients. Glasgow Coma Scale and NIH Stroke Scale scores were recorded to assess neurologic status on baseline and follow-up visits (24 hours, 48 hours, 7th day, and 3rd month). They also determined the d-dimer temporal profile at follow-up visits in a subgroup of 21 patients. ICH volume was measured on baseline and follow-up CT scans. Early neurologic deterioration (END) and mortality during the 1st week were recorded.

Results: ICH patients showed higher plasma d-dimer level than reference laboratory values at baseline (1,780 vs 360 ng/mL; p = 0.013) and 3 months after ICH onset (1,530 vs 470 ng/mL; p = 0.013). The d-dimer level was related to baseline ICH volume (r = 0.23, p = 0.049) and to the presence of intraventricular (2,370 vs 1,360 ng/mL; p = 0.019) or subarachnoid (4,180 vs 1,520 ng/mL; p = 0.001) extension. Nearly one-fourth of patients presented END, and 20% died as a result of ICH. As predictors of END, the authors identified d-dimer level >1,900 ng/mL (odds ratio [OR] 4.5, 95% CI 1.03 to 20.26, p = 0.045) and systolic blood pressure >182 mm Hg (OR 6.8, 95% CI 1.25 to 36.9, p = 0.026). Moreover, ICH volume >30 mL (OR 19.13, 95% CI 2.06 to 177, p = 0.009) and d-dimer levels >1,900 ng/mL (OR 8.75, 95% CI 1.41 to 54.16, p = 0.020) emerged as independent predictors of mortality.

Conclusion: Increased plasma d-dimer level following acute intracerebral hemorrhage is associated with early neurologic deterioration and poor outcome.

Disclosure: The authors report no conflicts of interest.

Received October 5, 2005. Accepted in final form March 16, 2006.






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