The utility of quantitative D-Dimer assay as a biomarker in the diagnosis and exclusion of Cerebral Venous Sinus Thrombosis

Thrombotic disorders are characterized by the presence of elevated levels of detectable fibrin degradation products in the blood. The utility and sensitivity of quantitative D-Dimer assay to rule out the diagnosis of deep vein thrombosis is well established. We extrapolated this principle to evaluate the utility of D-Dimer assay in exclusion of cerebral venous sinus thrombosis (CVST). CVST is an important cause of cerebrovascular accidents in young patients and the residual neurological deficits can be minimized if correct therapy, i.e., anticoagulation is instituted in a timely manner. As advanced imaging modalities that are required for the diagnosis of CVST might not be readily available everywhere, it is important to have a sensitive biomarker which can guide clinicians to rule out the diagnosis with a reasonable confidence. We evaluated the patients admitted at a tertiary care center who underwent Computed tomography (CT) Venography/Magnetic resonance (MR) Venography of the brain with the clinical suspicion of CVST. After appropriate exclusion, a quantitative D-Dimer assay was performed in patients who had CVST on CT/MR Venography and was compared with those patients who did not. Receiver operating characteristic (ROC) analysis revealed that quantitative D Dimer had poor diagnostic accuracy for the differentiation of CVST from non CVST cases (Area under the curve = 0.694), but D-Dimer levels of <300 ng/mL had a sensitivity of 90% for ruling out the diagnosis of CVST. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Ethics Comitee, Postgraduate Institute of Medical Education and Research, Chandigarh. Approval no - INT/IEC/2020/SPL-S14. Written consent was obtained from all the study participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable All relevant data are within the manuscript.