Study Discovers Possible Biomarker for Recurrent Stroke in Patients with ESUS

In this prospective study, the researchers included a total of 1431 patients with undetermined source and divided them into quartiles according to their baseline plasma d-dimer levels (Q1, Q2, Q3, Q4). The major outcome assessed was the occurrence of recurrent stroke (ischemic or hemorrhagic) in the year following the stroke event.

Key findings of the study were:

• Upon analysis, the researchers noted that the risk of recurrent stroke increased significantly with the increasing d-dimer quartile.
• They found that the patients in the higher d-dimer quartiles had a higher probability of recurrent embolic stroke because of covert atrial fibrillation, hidden malignancy, or undetermined sources.
• They noted that most recurrent strokes in Q3 and Q4 were embolic but not in Q1 or Q2.
• Upon multivariate analysis, they found that patients in Q3 and Q4 had a significantly increased risk of recurrent stroke compared with those in Q1 (hazard ratio:7.29 vs 3.12).
• Upon binary analysis, they found a significant association between a high d-dimer level above the normal range and the risk of recurrent stroke (hazard ratio, 2.48).
• In subgroup analysis, they noted that the high d-dimer level was associated with a significantly higher risk of recurrent stroke in men than in women.

The authors concluded, "Our findings suggest that d-dimer levels can be a useful risk assessment biomarker for predicting recurrent stroke, especially embolic ischemic stroke, in patients with undetermined source."

For further information:

https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033217