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The Utility of Quantitative D-Dimer Assay as a Biomarker in the Diagnosis and Exclusion of Cerebral Venous Sinus Thrombosis

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Abstract

The utility and sensitivity of quantitative D-Dimer assay to rule out the diagnosis of deep vein thrombosis is well established. We extrapolated this principle to evaluate the utility of D-Dimer assay in exclusion of cerebral venous sinus thrombosis (CVST). As advanced imaging modalities required for the diagnosis of CVST might not be available everywhere, it is important to have a sensitive biomarker and a clinical decision rule which can assist in the diagnosis. Patients undergoing CT/MR Venography of the brain with the suspicion of CVST were enrolled. Quantitative D-Dimer assay was performed in those who had CVST on CT/MR Venography and was compared with those who did not. A Clinical decision rule for the diagnosis of CVST was formulated using logistic regression analysis. Receiver operating characteristic analysis evaluating the diagnostic accuracy of D Dimer for patients with CVST as compared to those who did not revealed an AUROC of 0.694. D-Dimer levels of < 300 ng/mL had a sensitivity of 90% for the exclusion of CVST. After logistic regression analysis, a clinical decision rule with a total score of 16 and individual components of Female gender (2 points), Headache (7 points), D-Dimer levels of ≥ 792 ng/mL (7 points) was proposed. D-Dimer had a poor diagnostic accuracy for differentiation of patients who had CVST from those who did not, however, had a high sensitivity at values < 300 ng/mL. The proposed clinical decision rule with a score of ≥ 9 had a good diagnostic accuracy in prediction of CVST (AUROC = 0.809).

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Data Availability

This manuscript is available as an open access pre-print at medRxiv at: https://www.medrxiv.org/content/10.1101/2022.12.21.22283814v1. DOI—https://doi.org/10.1101/2022.12.21.22283814

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Acknowledgements

The authors would like to acknowledge the help provided by the coagulation laboratory staff, Mr. Chanderhans and Ms. Anita Kler. We would also like to extend our gratitude to Junior administrative assistant, Mr. Ajay Kumar for his input in statistical analysis.

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Authors and Affiliations

  1. Department of Internal Medicine, PGIMER, Chandigarh, India

    Dipesh Soni, Ashok Kumar Pannu & Atul Saroch

  2. Department of Radiodiagnosis PGIMER, Chandigarh, India

    Vikas Bhatia

  3. Department of Hematology, PGIMER, Chandigarh, India

    Jasmina Ahluwalia

  4. Department of Neurology PGIMER, Chandigarh, India

    Rajveer Singh

  5. Department of Clinical Hematology and Medical Oncology, PGIMER, Chandigarh, India

    Arihant Jain

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  1. Dipesh Soni
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  2. Ashok Kumar Pannu
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Correspondence to Atul Saroch.

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Soni, D., Pannu, A.K., Saroch, A. et al. The Utility of Quantitative D-Dimer Assay as a Biomarker in the Diagnosis and Exclusion of Cerebral Venous Sinus Thrombosis. Indian J Hematol Blood Transfus 40, 122–129 (2024). https://doi.org/10.1007/s12288-023-01677-8

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