Q: What is the cut off point of D-Dimer to rule out Aortic dissection (AD)?


Answer: Below 500 ng/mL

D-dimer is a strong serum marker for acute dissection. Level below 500 ng/mL has a negative predictive value of 96 percent to rule out aortic dissection. But still it is not a standard in clinical practice, as AD has been reported in patients below 400 ng/mL.


References:


1. Suzuki T, Distante A, Zizza A, et al. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation 2009; 119:2702. 

2. Shimony A, Filion KB, Mottillo S, et al. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am J Cardiol 2011; 107:1227. 

3. Paparella D, Malvindi PG, Scrascia G, et al. D-dimers are not always elevated in patients with acute aortic dissection. J Cardiovasc Med (Hagerstown) 2009; 10:212.

4. Asha SE, Miers JW. A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection. Ann Emerg Med 2015; 66:368. 

5. Marill KA. Serum D-dimer is a sensitive test for the detection of acute aortic dissection: a pooled meta-analysis. J Emerg Med 2008; 34:367.