The role of the D-dimer to fibrinogen ratio in the classification of cardioembolism and atherosclerotic stroke

Lei Chen; Minmin Zhang; Longjuan Yu; Meihua Huyan; Ming Zhao; Benqiang Deng; Ping Zhang

doi:10.1016/j.jocn.2024.05.007

The role of the D-dimer to fibrinogen ratio in the classification of cardioembolism and atherosclerotic stroke

J Clin Neurosci. 2024 May 14:125:43-50. doi: 10.1016/j.jocn.2024.05.007. Online ahead of print.

Authors

Lei Chen¹, Minmin Zhang¹, Longjuan Yu¹, Meihua Huyan¹, Ming Zhao², Benqiang Deng³, Ping Zhang⁴

Affiliations

¹ Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
² Department of Neurology, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China.
³ Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China. Electronic address: chnxgnk@163.com.
⁴ Department of Neurology, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China. Electronic address: pingzhang1121@163.com.

PMID: 38749330
DOI: 10.1016/j.jocn.2024.05.007

Abstract

Background: The D-dimer-to-fibrinogen ratio (DFR) is a good indicator of thrombus activity in thrombotic diseases, but its clinical role in acute ischaemic stroke (AIS) patients with different etiologies has not been studied. We evaluated the diagnostic value of the DFR for different subtypes of AIS.

Methods: We conducted a single-center retrospective study of 269 patients with AIS who were referred to our stroke center within 4.5 h from Jan 2017 to Oct 2019. Coagulation data including DFRs were compared among the different stroke subtypes, and a separate retrospective validation sample was utilized to evaluate the prediction efficiency of the DFR for subtype diagnosis.

Results: A higher DFR was observed in patients with cardioembolism than in those with large artery atherosclerosis (LAA) (odds ratio (OR) per 0.1 increase of the DFR: 1.49 [1.01-2.18]) after we adjusted for vascular risk factors. The diagnostic value of the DFR for detecting cardioembolism (AUC = 0.722, 95 % CI = 0.623-0.820) exceeded that of isolated D-dimer or fibrinogen. The validation sample (n = 117) further supported the notion that a diagnosis of cardioembolism was more common in patients with a DFR > 0.11 (multivariable risk ratio = 3.11[1.33-7.31], P = 0.009).

Conclusion: High DFRs were associated with cardioembolism in patients with AIS. The utilization of DFR can be beneficial for distinguishing a cardiac embolic source from atherosclerotic stroke.

Keywords: Cardioembolism; D-dimer; Fibrinogen; Ischemic stroke.