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Could the combination of fibrinogen and D-dimer improve risk assessment for acute type A aortic dissection in the emergency department?

Teurneau-Hermansson, Karl LU orcid ; Norén, Emilia ; Ede, Jacob LU orcid ; Larsson, Mårten LU ; Björkelund, Anders LU ; Sjögren, Johan LU ; Nozohoor, Shahab LU orcid ; Ekelund, Ulf LU orcid and Zindovic, Igor LU (2026) In Scandinavian Journal of Clinical and Laboratory Investigation
Abstract

D-dimer has been proven to be an excellent rule-out marker for acute type A aortic dissection (ATAAD) with a sensitivity exceeding 95% while specificity remains low. We hypothesized that the addition of fibrinogen, which is decreased in ATAAD patients due to consumption coagulopathy, would increase predictive ability. This was an exploratory, retrospective, single-region, observational study comparing ATAAD patients with available preoperative D-dimer and fibrinogen values who underwent surgery at our department between 2008 and 2023 (93 patients) to all patients who visited an emergency department (ED) in a region of southern Sweden during 2017 and 2018 and whose D-dimer and fibrinogen values were obtained within 24 h (202 patients).... (More)

D-dimer has been proven to be an excellent rule-out marker for acute type A aortic dissection (ATAAD) with a sensitivity exceeding 95% while specificity remains low. We hypothesized that the addition of fibrinogen, which is decreased in ATAAD patients due to consumption coagulopathy, would increase predictive ability. This was an exploratory, retrospective, single-region, observational study comparing ATAAD patients with available preoperative D-dimer and fibrinogen values who underwent surgery at our department between 2008 and 2023 (93 patients) to all patients who visited an emergency department (ED) in a region of southern Sweden during 2017 and 2018 and whose D-dimer and fibrinogen values were obtained within 24 h (202 patients). The discriminative capacity of ATAAD was evaluated by comparing the area under the curve (AUC) from receiver operating characteristics (ROC) curves calculated for each biomarker alone and for the D-dimer/fibrinogen ratio. The AUC for the ability of D-dimer and fibrinogen to discriminate ATAAD from other diagnoses was 0.784 (95% CI 0.733–0.836) and 0.756 (95% CI 0.701–0.811), respectively. The AUC for the D-dimer/fibrinogen ratio was 0.812 (95% CI 0.764–0.860). In this exploratory study, we could show that the D-dimer/fibrinogen ratio increased the ability to predict ATAAD compared to the biomarkers alone. The improvement in discriminative ability was small, however, and needs further validation to be clinically useful.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
aortic dissections, ascending aorta, D-dimer, fibrinogen, Thoracic aorta
in
Scandinavian Journal of Clinical and Laboratory Investigation
publisher
Informa Healthcare
external identifiers
  • scopus:105030260615
  • pmid:41685423
ISSN
0036-5513
DOI
10.1080/00365513.2026.2630321
language
English
LU publication?
yes
id
888c9d58-147d-4fb8-914f-7f91c710870d
date added to LUP
2026-03-02 12:05:20
date last changed
2026-03-30 18:50:05
@article{888c9d58-147d-4fb8-914f-7f91c710870d,
  abstract     = {{<p>D-dimer has been proven to be an excellent rule-out marker for acute type A aortic dissection (ATAAD) with a sensitivity exceeding 95% while specificity remains low. We hypothesized that the addition of fibrinogen, which is decreased in ATAAD patients due to consumption coagulopathy, would increase predictive ability. This was an exploratory, retrospective, single-region, observational study comparing ATAAD patients with available preoperative D-dimer and fibrinogen values who underwent surgery at our department between 2008 and 2023 (93 patients) to all patients who visited an emergency department (ED) in a region of southern Sweden during 2017 and 2018 and whose D-dimer and fibrinogen values were obtained within 24 h (202 patients). The discriminative capacity of ATAAD was evaluated by comparing the area under the curve (AUC) from receiver operating characteristics (ROC) curves calculated for each biomarker alone and for the D-dimer/fibrinogen ratio. The AUC for the ability of D-dimer and fibrinogen to discriminate ATAAD from other diagnoses was 0.784 (95% CI 0.733–0.836) and 0.756 (95% CI 0.701–0.811), respectively. The AUC for the D-dimer/fibrinogen ratio was 0.812 (95% CI 0.764–0.860). In this exploratory study, we could show that the D-dimer/fibrinogen ratio increased the ability to predict ATAAD compared to the biomarkers alone. The improvement in discriminative ability was small, however, and needs further validation to be clinically useful.</p>}},
  author       = {{Teurneau-Hermansson, Karl and Norén, Emilia and Ede, Jacob and Larsson, Mårten and Björkelund, Anders and Sjögren, Johan and Nozohoor, Shahab and Ekelund, Ulf and Zindovic, Igor}},
  issn         = {{0036-5513}},
  keywords     = {{aortic dissections; ascending aorta; D-dimer; fibrinogen; Thoracic aorta}},
  language     = {{eng}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Clinical and Laboratory Investigation}},
  title        = {{Could the combination of fibrinogen and D-dimer improve risk assessment for acute type A aortic dissection in the emergency department?}},
  url          = {{http://dx.doi.org/10.1080/00365513.2026.2630321}},
  doi          = {{10.1080/00365513.2026.2630321}},
  year         = {{2026}},
}