Back
Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels.
Journal article

Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels.

  • Heldner MR From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland. mirjam.heldner@insel.ch.
  • Zuurbier SM From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Li B From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Von Martial R From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Meijers JCM From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Zimmermann R From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Volbers B From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Jung S From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • El-Koussy M From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Fischer U From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Kohler HP From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Schroeder V From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Coutinho JM From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
  • Arnold M From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
Show more…
  • 2020-06-25
Published in:
  • Neurology. - 2020
Adolescent
Adult
Aged
Aged, 80 and over
Computed Tomography Angiography
Female
Fibrin Fibrinogen Degradation Products
Headache
Humans
Intracranial Thrombosis
Male
Middle Aged
Predictive Value of Tests
Venous Thrombosis
Young Adult
English OBJECTIVE
To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels.


METHODS
This prospective multicenter study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood sampling for D-dimers measuring (ELISA test), and magnetic resonance/CT venography. Predictive value of clinical variables and D-dimers for CVT was calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established with multivariate logistic regression.


RESULTS
CVT was confirmed in 26.2% (94 of 359) of patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point), and focal neurologic deficit at presentation (1 point) (area under the curve [AUC] 0.889). We defined 0 to 2 points as low CVT probability (negative predictive value [NPV] 94.1%). Of the 186 (51.8%) patients who had a low probability score, 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34 of 120) in patients with a moderate (3-5 points) and 92.5% (49 of 53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500 μg/L. Predictive value of D-dimers for CVT for >675 μg/L (best cutoff) vs >500 μg/L was as follows: sensitivity 77.7%, specificity, 77%, NPV 90.7%, and accuracy 77.2% vs sensitivity 89.4%, specificity 66.4%, NPV 94.6%, and accuracy 72.4%, respectively. Adding the clinical score to D-dimers >500 μg/L resulted in the best CVT prediction score explored (at the cutoff ≥6 points: sensitivity 83%/specificity 86.8%/NPV 93.5%/accuracy 84.4%/AUC 0.937).


CONCLUSION
The proposed new clinical score in combination with D-dimers may be helpful for predicting CVT as a pretest score; none of the patients with CVT showed low clinical probability for CVT and D-dimers <500 μg/L.


CLINICALTRIALSGOV IDENTIFIER
NCT00924859.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/111302
Statistics
Document views: 27 File downloads: