Diagnostic accuracy of biomarker D-dimer in patients after stroke suspected from venous thromboembolism: A diagnostic meta-analysis

Abstract

D-dimer is a promising biomarker for identification of venous thromboembolism (VTE) in patients with stroke. The purpose of our study is to evaluate the diagnostic value of D-dimer as a promising biomarker for VTE in patients after stroke. We performed an exhaustive search of leading databases including Pubmed, Embase, the Cochrane library, China National Knowledge Infrastructure (CNKI), and China Biology Medicine disc (CBM) from inception to Oct 13, 2017. We included studies written in English and Chinese. We included studies that appraised the diagnostic value of D-dimer with reference standard for VTE diagnosis in patients after stroke. We concurrently constructed a 2 × 2 table with data extracted from included studies. We identified 8 studies that included 1490 patients after stroke from our database searches. The pooled result from limited evidence showed a sensitivity of 0.85 (95% CI 0.76–0.90) and a specificity of 0.77 (95% CI 0.73–0.81). The area under the summary receiver operating characteristic curve was 0.85(95% CI 0.81–0.88). The positive likelihood ratio (LR+) and the negative likelihood ratio (LR-) were 3.8 (95% CI 3.1–4.4) and 0.20(95% CI 0.12–0.31), respectively. In patients after stroke suspected of venous thromboembolism, D-dimer is a beneficial biomarker for diagnosis of VTE. For stroke patients with low probability of VTE, a normal D-dimer test can be used to rule-out VTE. However, we do not recommend using D-dimer as the single definitive test for VTE diagnosis. We recommend diagnosing VTE using multi-branch diagnostic strategy.