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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Emergency Medicine

Advisor

Laura Witte

Abstract

Purpose: The purpose of this article is to evaluate the utility of using a d-dimer assay for the purpose of diagnosing atrial thrombus in the setting of atrial fibrillation.

Method: A PubMed and MEDLINE literature search was conducted using the search phrase “(d-dimer OR fibrin fragment D OR d-dimer fibrin OR d-dimer fragments OR fibrin fragment D1 dimer OR fibrin fragment DD OR fibrin fragment D-dimer) AND (atrial thrombus OR atrial clot OR atrial thrombi).” Relevant articles were reviewed and provide the foundation for this clinical review.

Results: Using the d-dimer assay to rule out atrial thrombus was found to have a comparable negative predictive value to transesophageal echocardiography, the current diagnostic gold standard.

Conclusion: The D-dimer assay is a coagulation biomarker that is frequently used to evaluate deep vein thrombus and pulmonary embolism. Research for its clinical use in other clotting states is ongoing. Using the D-dimer assay for the exclusion of atrial thrombus may be clinically useful as its negative predictive value has been shown to be comparable to transesophageal echocardiography. However, more research needs to be done to establish its effectiveness in this setting and to standardize an appropriate cutoff value. This has the potential to change the course of future guidelines in the management of supraventricular tachyarrhythmias.

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