This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

D‐dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery. BJS 2004; 91: 991-994.

Published: 11th June 2004

Authors: S. Acosta, T. K. Nilsson, M. Björck

Background

There is no accurate non‐invasive method available for the diagnosis of acute thromboembolic occlusion of the superior mesenteric artery (SMA). The aim of this study was to assess the diagnostic properties of the fibrinolytic marker D‐dimer.

Method

From September 2000 to April 2003 consecutive patients aged over 50 years admitted to hospital with acute abdominal pain were studied. Patients with possible acute SMA occlusion at presentation had blood samples taken within 24 h of the onset of the pain for analysis of D‐dimer, plasma fibrinogen, activated partial thromboplastin time, prothrombin time and antithrombin. The value of D‐dimer testing to diagnose SMA occlusion was assessed by means of likelihood ratios.

Results

Nine of 101 patients included had acute SMA occlusion. The median D‐dimer concentration was 1·6 (range 0·4–5·6) mg/l, which was higher than that in 25 patients with inflammatory disease (P = 0·007) or in 14 patients with intestinal obstruction (P = 0·005). The combination of a D‐dimer level greater than 1·5 mg/l, atrial fibrillation and female sex resulted in a likelihood ratio for acute SMA occlusion of 17·5, whereas no patient with a D‐dimer concentration of 0·3 mg/l or less had acute SMA occlusion.

Conclusion

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