Abstract WMP49: Higher Risk Of Stroke Recurrence With Increased Plasma D-dimer Levels: A Systematic Review And Meta-analysis

Abstract

Background: D-dimer has been evaluated as an independent marker of ischemic stroke. The non-existence of a clear consensus and pooled data about the use of D-dimer as a predictive biomarker for assessing the risk of stroke recurrence led us to perform this systematic review and meta-analysis. Methods: Studies reporting the risk of stroke recurrence with varying degrees of high D-dimer levels were screened through August 2021 using PubMed/Medline, Scopus, EMBASE and Web of Science databases and relevant keywords. Random effects models by Dersimonian & Laird were used for meta-analysis and subgroup analysis. I 2 statistics were used for heterogeneity assessment. The leave-one-out method was used for sensitivity analysis. Results: This systematic review included 5040 patients from 9 studies consisting of >60% males. There was a high burden of cardiovascular comorbidities, smoking and diabetes in stroke patients with or without associated diagnoses and high D-dimer levels. Compared to low D-dimer levels, higher plasma D-dimer levels were associated with ~80% (aOR 1.79, 95% CI: 1.24-2.59) increased risk of stroke recurrence. The odds of stroke recurrence were significantly high in the stroke cohorts including patients with mean age <70 years (OR 2.44, 95%CI:1.00-5.94, p<0.05) with high D-dimer levels (Fig. 1) . In addition, elevated D-dimer levels showed a robust association for stroke recurrence in studies with higher sample size (n>500 vs. n<500: OR 2.48, 95%CI:1.18-5.19, p<0.05) and studies reporting late recurrence (vs. early recurrence: ≥1 month vs <1 month: OR 2.07, 95%CI:1.23-2.55, p<0.01). Conclusion: This meta-analysis showed that high D-dimer levels were associated with nearly 80% higher odds of stroke recurrence irrespective of the etiology of index stroke events. Stronger associations were seen in studies with a mean age <70 years and a higher sample size. Late-onset recurrence had a stronger association with high D-dimer levels compared to early-onset.