I have been doing some research today while working on my new website. I personally believe that had it not been for this D-dimer blood test in the ER room on me, I might not be writing this post in my blog now. You can read all the studies about the D-dimer effectiveness in DVT and Pulminary embolisms called the The D-dimer assay you can trust. The company behind this test is SimpliRED. The actual blood test takes about 2 minutes.
During blood coagulation, fibrinogen is converted to fibrin by the activation of thrombin. Fibrin monomers polymerise to form a soluble gel of non-cross linked fibrin. The fibrin gel is then converted to cross linked fibrin by thrombin activated factor XIII to form an insoluble clot. To prevent complete obstruction of circulation, clot lysis is triggered by plasmin at the same time as a clot forms. This is called fibrinolysis. Fibrinogen, fibrin and cross linked fibrin are all cleaved by plasmin during fibrinolysis but only degradation products from cross linked fibrin contain D-dimer. Therefore, D-dimer is a marker of active coagulation and fibrinolysis.
The link between raised D-dimer levels and thrombotic conditions such as deep vein thrombosis (DVT) and pulmonary embolism (PE) is well established. D-dimer testing is used as an aid in the diagnosis of both of these conditions (often collectively referred to as venous thrombembolism or VTE) as well as disseminated intravascular coagulation and hence plays an important role in the effective management of these serious clinical conditions.
SimpliRED D-dimer Principle
SimpliRED D-dimer is a whole blood agglutination assay for the identification of D-dimer. The active component is a conjugate of D-dimer specific monoclonal antibody joined to a monoclonal antibody that binds to the outside of red blood cells. When this bi-specific conjugate is mixed with patient whole blood, agglutination of the red blood cells will occur if the D-dimer concentration is above the cut-off level. In the absence of D-dimer, no agglutination takes place. The crosslinked fibrin breakdown products D-dimer, D-dimer E and derivates with a high molecular weight are all recognised by SimpliRED D-dimer.
Knowing what I know, I would at least DEMAND this blood test and see if it comes back high for a pulmonary embolism. Then, most good doctors would order a CT scan and then the Aortic Dissection would show up like it did in my case. If they won’t get you a CT/Angio scan, at least get the blood test.
The last thing that you want to have happen to your family member is to be sent home. It’s amazing, but these days you have got to have some basic knowledge of what chest/back pain of a dissection might be causing someone. The other issue is that you have to hope you have an ER doctor who is not too busy to be able to devote enough time (and time is critical when you have had an ascending aortic dissection), so you need to be keeping tabs on what’s going on in there!
In summary, make it a point to keep demanding proof that your ER doctor can rule out that your loved one isn’t having a dissection or has not had one. Either a CT scan or D-dimer results or MRI. Be persistant! You might only have one chance!