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Original research
Emergency admission plasma D-dimer: a novel predictor for symptomatic intracranial hemorrhage after thrombectomy in acute ischemic stroke
  1. Kai Qiu1,
  2. Zhen Yu Jia1,
  3. Yuezhou Cao1,
  4. Lin-Bo Zhao2,
  5. Qingquan Zu1,
  6. Hai-Bin Shi1,
  7. Sheng Liu1
  1. 1Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
  2. 2Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, JiangSu, China
  1. Correspondence to Dr Sheng Liu, Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China; liusheng{at}


Background Symptomatic intracranial hemorrhage (sICH) is a common and severe complication in patients with acute ischemic stroke (AIS) after treatment with thrombectomy.

Objective To explore the ability of admission plasma D-dimer levels to predict sICH after thrombectomy.

Methods Between February 2018 and August 2021, consecutive patients with AIS who underwent thrombectomy at our single comprehensive stroke center were retrospectively enrolled. sICH was defined according to the criterion of the Heidelberg Bleeding Classification. Logistic regression analysis was performed to determine the risk factors of sICH. The overall discriminative ability of D-dimer levels in predicting sICH was evaluated by adopting a receiver operating characteristic (ROC) curve.

Results Of the 395 enrolled patients, 48 (12.2%) had sICH. Patients with sICH were older (72.9 vs 69.3 years, P=0.037), more often female (62.5% vs 45.5%, P=0.027), had higher D-dimer levels (2.70 vs 0.74 mg/L, P<0.001), higher National Institutes of Health Stroke Scale score (20 vs 15, P<0.001), lower Alberta Stroke Program Early CT Score (8 vs 9, P<0.001), a higher proportion of internal carotid artery occlusions (56.2% vs 30.3%, P<0.001), and less commonly had large-artery atherosclerosis stroke etiology (12.5% vs 32.3%, P=0.010) than patients without sICH. After adjustment for potential confounders, D-dimer levels (adjusted OR=2.45, 95% CI 1.75 to 3.43, P<0.001) remained significantly associated with sICH. Based on the ROC, the D-dimer as a predictor for predicting sICH, presented with a specificity of 86.2%, a negative predictive value of 94.6%, and an area under the curve of 0.774.

Conclusion Elevated admission D-dimer levels are an independent predictor of sICH in patients with AIS after thrombectomy.

  • stroke
  • thrombectomy
  • hemorrhage
  • intervention
  • brain

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • KQ and ZYJ are joint first authors.

  • Contributors Guarantor of the overall content of the entire study: SL. Study concepts and design: KQ, ZYJ, H-BS, SL. Literature research: KQ, ZYJ, YC, L-BZ, QZ, H-BS, SL. Clinical studies: ZYJ, YC, L-BZ, QZ, H-BS, SL. Experimental studies/data analysis: NA. Statistical analysis: KQ, SL. Manuscript preparation: KQ, ZYL, SL. Manuscript editing: ZYL, SL.

  • Funding This study was funded by the Social Development Projects of Jiangsu Province (BE2022809 to SL). National Natural Science Foundation of China (81971613 to H-BS). Clinical ability improvement project of the First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital) (JSPH-MC-2020-8 to Q-QZ).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.