Plasma D-dimer predicts poor outcome after acute intracerebral hemorrhage

Objective: To investigate if systemic D-dimer activation occurs after acute intracerebral hemorrhage (ICH) and to study its influence on clinical outcome. Methods: The authors determined plasma baseline D-dimer in 98 consecutive acute (< 24 hours) ICH patients. Glasgow Coma Scale and NIH Stroke Scale scores were recorded to assess neurologic status on baseline and follow-up visits (24 hours, 48 hours, 7th day, and 3rd month). They also determined the D-dimer temporal profile at follow-up visits in a subgroup of 21 patients. ICH volume was measured on baseline and follow-up CT scans. Early neurologic deterioration (END) and mortality during the 1st week were recorded. Results: ICH patients showed higher plasma D-dimer level than reference laboratory values at baseline (1,780 vs 360 ng/mL; p = 0.013) and 3 months after ICH onset (1,530 vs 470 ng/ mL; p = 0.013). The D-dimer level was related to baseline ICH volume (r = 0.23, p = 0.049) and to the presence of intraventricular (2,370 vs 1,360 ng/ mL; p = 0.019) or subarachnoid (4,180 vs 1,520 ng/ mL; p = 0.001) extension. Nearly one-fourth of patients presented END, and 20% died as a result of ICH. As predictors of END, the authors identified D-dimer level > 1,900 ng/ mL (odds ratio [OR] 4.5, 95% CI 1.03 to 20.26, p = 0.045) and systolic blood pressure > 182 mm Hg (OR 6.8, 95% CI 1.25 to 36.9, p = 0.026). Moreover, ICH volume > 30 mL (OR 19.13, 95% CI 2.06 to 177, p = 0.009) and D-dimer levels > 1,900 ng/ mL (OR 8.75, 95% CI 1.41 to 54.16, p = 0.020) emerged as independent predictors of mortality. Conclusion: Increased plasma D-dimer level following acute intracerebral hemorrhage is associated with early neurologic deterioration and poor outcome.