D‐dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta‐analysis of the literature

Summary. Background: Quantitative measurement of circulating D‐dimer, a product of fibrin degradation, has been shown to be a very useful diagnostic tool in the management of patients with suspected deep vein thrombosis and/or pulmonary embolism. Whether D‐dimer can play a similar role in the diagnostic approach to patients with suspected cerebral vein thrombosis (CVT) remains controversial.Methods: Studies evaluating the diagnostic accuracy of the D‐dimer test in the diagnosis of CVT were systematically searched for in the MEDLINE and EMBASE databases (up to July 2011). Weighted mean sensitivity and specificity with 95% confidence intervals (CIs) were calculated with a bivariate random‐effects regression approach.Results: Fourteen studies, for a total of 1134 patients, were included. D‐dimer accuracy was good, with a resulting weighted mean sensitivity of 93.9% (95% CI 87.5–97.1) and weighted mean specificity of 89.7% (95% CI 86.5–92.2), calculated with a bivariate approach. Potential risk factors for false‐negative D‐dimer results included isolated headache, longer duration of symptoms, and limited sinus involvement.Conclusions: Our findings suggest that D‐dimer may be a useful diagnostic tool in the management of patients with suspected CVT. Future prospective studies are warranted to confirm our preliminary findings.