D-Dimer to Rule out Aortic Dissection

Patients with acute aortic syndrome, may be very difficult to diagnose. Patients who present with textbook ripping severe chest pain and accompanying focal neurology and have findings of a pulse deficit and blood pressure difference in the upper limbs as well as a new aortic incompetence murmur and a new pericardial effusion on point of care ultrasound, are straightforward. Many cases however are not so textbook and patient can present with no chest pain, but symptoms of malperfusion following a dissection, presenting challenge to making the diagnosis. (20 minutes read)

In this review the question they wanted to answer was, can the D-dimer (DD) with the Aortic Dissection Detection Risk Score (ADD-RS)(1), in low risk patients, be used to rule out Acute Aortic Syndromes (AAS)? This would see its application in the same way as we use the DD with low risk patients to rule out deep venous thrombosis or pulmonary embolism.

This was a systematic review of the ADD-RS plus DD to rule out acute aortic syndromes (2). Of all studies found, 4 studies were reviewed. A total of 3804 patients were included. 675 patients had AAS.