Plasma D-dimer as a biomarker for the early classifcation of common acute ischemic stroke subtypes in Indonesia

Background D-dimer is a well-known marker for abnormal hemostasis in acute ischemic stroke (AIS), indicating the presence of fbrin degradation due to thrombus formation and lysis. The diagnostic performance of D-dimer for diferent AIS types in the Indonesian population has not been established. The aim of this study is to compare the plasma D-dimer levels in three of the most common AIS subtypes in Indonesia; the cardioembolic, large artery atherosclerosis (LAA), and small-vessel occlusion (SVO), and to determine its most optimal diagnostic performance. Results In this cross-sectional study, 64 subjects with confrmed AIS diagnosis at the Wahidin Sudirohusodo Gen- eral Hospital Makassar between June and October 2019 were recruited. Plasma D-dimer levels were measured and grouped according to the subtype of acute ischemic stroke based on the TOAST classifcation. A signifcant difer- ence was observed between the D-dimer levels across the three AIS subtypes, with an average D-dimer of 2.93±1.7, 1.27±0.81, and 0.56±0.46 μg/ml in the cardioembolic, LAA, and SVO subtypes, respectively. As a marker of cardioem- bolic stroke, an optimal cut-of was determined to be 1.52 μg/ml, yielding a sensitivity of 84.44% (CI 71.22–92.25% and specifcity of 84.21% (CI 62.43–94.48%). Conclusion Plasma D-dimer levels varied signifcantly between the cardioembolic, LAA, and SVO subtypes of AIS, with the highest D-dimer level in the cardioembolic subtypes. As a marker of cardioembolic stroke, an optimal cut-of was determined to be 1.52 μg/mL, yielding a sensitivity and specifcity of 84.44% and 84.21%, respectively. Keywords Acute ischemic stroke, Plasma D-dimer levels, TOAST classifcation