D-dimer for the exclusion of cerebralvenous thrombosis: a meta-analysis of lowrisk patients with isolated headache

Background: sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with isolated headache. Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven Methods: normal neurological examination and normal standard head CT in whom D-dimer was determined. Additionally we did a systematic review on articles describing consecutive patients suspected of CVT with isolated headache and their D-dimer values. CVT was investigated with CT or MR venography in all patients. We included consecutive patients suspected of CVT from our teaching hospital with isolated headache, a Results: patients one had a negative D-dimer (7.5 %). Sensitivity of D-dimer for diagnosing CVT was 97.8 % (95 % CI: 88.2 specificity was 84.9 % (95 % CI: 81.8 predictive value was 99.8 % (95 % CI: 98.9 literature, lacking consecutive isolated headache controls. Sensitivity of D-dimer for diagnosing CVT including these patients was 87.1 % (95 % CI: 79.0 A total of 636 consecutive patients were collected from our own data and the literature search. Of 45 CVT – 99.6 %), – 87.7 %), positive predictive value was 33.1 % (95 % CI: 25.2 – 41.7 %), negative – 100 %). Another 56 isolated headache CVT patients were identified in – 93.0 %). Conclusions: CVT. Sensitivity is lower but comparable to the values accepted in PE and DVT. Low risk patients were defined as headache patients with a normal neurological examination, normal standard head CT and absence of risk factors such as pregnancy or puerperium. Normal D-dimers in these patients may reduce unnecessary imaging, making it a potential valuable marker. D-dimers have a high negative predictive value in patients with isolated headache for excluding