D-Dimer Level After Endovascular Treatment Can Help Predict Outcome of Acute Ischemic Stroke

Background: D-Dimer level is a marker of hypercoagulability, which is associated with thrombus formation and resolution. We investigated the value of d-dimer levels in predicting outcomes of acute ischemic stroke in patients who underwent endovascular treatment (EVT). Methods: We analyzed data of patients who underwent only EVT from the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) registry. d-Dimer levels were routinely measured in 10 of 15 participating hospitals. Patients were grouped into tertiles (tertile 1, tertile 2, and tertile 3) according to D-dimer levels (lowest, moderate, and highest, respectively). We compared serial scores on the National Institutes of Health Stroke Scale at baseline, on day 1 of hospitalization, and at discharge; functional outcome 3 months after EVT; and rate of mortality within 6 months after EVT. Results: In the 170 patients, the median d-dimer level was 477 ng/mL (interquartile range, 249-988 ng/mL). In tertile 3, the National Institutes of Health Stroke Scale score was higher at discharge than on day 1 of hospitalization. Poor outcome 3 months after EVT (modified Rankin Scale score, >= 3) was more common with high d-dimer levels (26.3% of tertile 1, 57.1% of tertile 2, and 76.4% of tertile 3; P<0.001). Multivariable analysis showed that a high d-dimer level was independently associated with poor outcome 3 months after EVT (odds ratio [OR], 4.399 [95% CI, 1.594-12.135]). Kaplan-Meier survival analysis showed that a high d-dimer level was independently associated with death within 6 months after EVT (OR, 5.441 [95% CI, 1.560-18.978]; log-rank test, P<0.001). The d-dimer effect showed no heterogeneity across the subgroups for poor outcome 3 months after EVT or death within 6 months after EVT. The direction of effect was unfavorable for tertile 3 across all demographic strata. Conclusions: High plasma D-dimer levels were predictive of early neurologic worsening, poor functional outcome 3 months after EVT, and death within 6 months after EVT.