The D-dimer assay: A possible tool in the evaluation of atrial thrombosis

Uzoma N. Ibebuogu, Ali K. Salah, Surender Malhotra, Joe B. Calkins, John W Thornton, Mahendra Mandawat, Vincent Jb Robinson

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Atrial fibrillation (AF) is a common arrhythmia seen in clinical practice, and affects more than 4% of the population older than 60 years of age. Peripheral thromboembolism contributes significantly to the observed morbidity and mortality. Symptomatic AF, before cardioversion to normal sinus rhythm, requires either exclusion of atrial thrombi using transesophageal echocardiography (TEE) or the conventional use of three weeks of adequate anticoagulation. The exclusion of atrial thrombi by TEE, a nontomographic technique but comparable with conventional treatment of AF in outcomes, has inherent limitations due to the complex three-dimensional multilobed anatomy of the left atrial appendage, where the majority of atrial thrombi arise. Also, the conventional treatment of three weeks of therapeutic anticoagulation before cardioversion reportedly does not always eliminate atrial thrombi. Plasma D-dimer constitutes an antigen-antibody reaction to the dimeric final degradation product of a mature clot. An elevated fibrin D-dimer has a high sensitivity for intravascular thrombosis and, hence, may improve the evaluation of a patient with AF before cardioversion in addition to a TEE. A case is presented in which a positive D-dimer resulted in performing TEE to document atrial thrombosis and the complications of previous bacterial endocarditis. In the present case, this involved aortic root abscess formation and acute aortic regurgitation because of flailing of the noncoronary cusp that resulted in recurrent pulmonary edema.

Original languageEnglish (US)
Pages (from-to)517-519
Number of pages3
JournalCanadian Journal of Cardiology
Volume24
Issue number6
DOIs
StatePublished - Jan 1 2008

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Thrombosis
Transesophageal Echocardiography
Atrial Fibrillation
Electric Countershock
Antigen-Antibody Reactions
Bacterial Endocarditis
Atrial Appendage
Aortic Valve Insufficiency
Thromboembolism
Pulmonary Edema
Abscess
fibrin fragment D
Cardiac Arrhythmias
Anatomy
Therapeutics
Morbidity
Mortality
Population

Keywords

  • Atrial fibrillation
  • Atrial thrombosis
  • D-dimer assay
  • Left atrial appendage
  • Thromboembolism
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The D-dimer assay : A possible tool in the evaluation of atrial thrombosis. / Ibebuogu, Uzoma N.; Salah, Ali K.; Malhotra, Surender; Calkins, Joe B.; Thornton, John W; Mandawat, Mahendra; Robinson, Vincent Jb.

In: Canadian Journal of Cardiology, Vol. 24, No. 6, 01.01.2008, p. 517-519.

Research output: Contribution to journalArticle

Ibebuogu, Uzoma N. ; Salah, Ali K. ; Malhotra, Surender ; Calkins, Joe B. ; Thornton, John W ; Mandawat, Mahendra ; Robinson, Vincent Jb. / The D-dimer assay : A possible tool in the evaluation of atrial thrombosis. In: Canadian Journal of Cardiology. 2008 ; Vol. 24, No. 6. pp. 517-519.
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