D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation.

Left atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient's age (DDAge), based on the cut-off used to exclude pulmonary embolism.
142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.
LA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; p<0.05). DDAge indicated absence of LA thrombus with higher specificity than DD500 (66.4% vs 50.4%; p<0.05). Both cut-offs were able to identify all 13 patients with LA thrombus (false negative 0%). Patients with D-dimers <DDAge and without LA thrombus (true negative) represented 60.6% of the population and could have safely avoided TOE (flow chart).
This study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.
AuthorsAlexandre Almorad, Anush Ohanyan, Georgiana Pintea Bentea, Jean-Yves Wielandts, Milad El Haddad, Michelle Lycke, Louisa O'Neill, Marielle Morissens, Eva De Keyzer, Thomas Nguyen, Laura Anghel, Sophie Samyn, Brahim Berdaoui, Rene Tavernier, Yves Vandekerckhove, Mattias Duytschaever, Thierry Verbeet, Sebastien Knecht, José Castro Rodriguez
JournalHeart (British Cardiac Society) (Heart) Vol. 107 Issue 3 Pg. 195-200 (02 2021) ISSN: 1468-201X [Electronic] England
PMID33087410 (Publication Type: Journal Article)
Copyright© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Chemical References
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation (complications)
  • Echocardiography, Transesophageal
  • Female
  • Fibrin Fibrinogen Degradation Products (analysis)
  • Heart Diseases (blood, diagnosis, etiology)
  • Humans
  • Male
  • Middle Aged
  • Thrombosis (blood, diagnosis, etiology)

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