Papercut: D-dimer to rule out Acute Aortic Syndrome

Patients with acute aortic syndrome, may be very difficult to diagnose. Patients who present with textbook ripping severe chest pain and accompanying focal neurology and have findings of a pulse deficit and blood pressure difference in the upper limbs as well as a new aortic incompetence murmur and a new pericardial effusion on point of care ultrasound, are straightforward. Many cases however are not so textbook and patient can present with no chest pain, but symptoms of malperfusion following a dissection, presenting challenge to making the diagnosis.

In this review the question they wanted to answer was, can the D-dimer (DD) with the Aortic Dissection Detection Desk Score (ADD-RS)(1), in low risk patients, be used to rule out Acute Aortic Syndromes (AAS)? This would see its application in the same way as we use the DD with low risk patients to rule out deep venous thrombosis or pulmonary embolism.

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