Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer - Strength of current evidence

Q: What question does the study aim to answer about D-dimer in stroke patients?

It evaluates whether baseline D-dimer levels in stroke differ between patients with cancer and those without cancer, and how that evidence can support screening for active or occult cancer.

Q: How were included studies identified and assessed for quality?

The review followed PRISMA guidelines, searched multiple databases up to June 2023, used independent iterative steps by two reviewers, and assessed study quality with the Newcastle-Ottawa scale for case-control and cohort studies and AHRQ tools for cross-sectional studies.

Q: What were the main findings regarding baseline D-dimer levels?

Baseline D-dimer levels were significantly higher in stroke patients with cancer than in non-cancer patients, with a mean difference of 4.84 (3.07–6.60) and P < 0.00001.

Sep 21, 2026

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Objectives assess evidence on baseline D-dimer levels in stroke patients with and without cancer, given higher stroke risk among cancer patients and uncertainty whether elevated D-dimer can indicate concomitant cancer or cancer-related stroke development. Methods include systematic review and meta-analysis following PRISMA, database searches through June 2023, independent iterative review by two reviewers, and quality appraisal using Newcastle-Ottawa and AHRQ tools. Results identify six eligible studies and show higher baseline D-dimer with cancer. Conclusion frames D-dimer as a simple biomarker for screening active or occult cancer.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Objectives, Materials and Methods

Results, Conclusion

Introduction

D-dimer as a biomarker

Rationale for the systematic review

Methods and Evidence Synthesis

Search strategy and study selection

Quality assessment and quantitative synthesis

[https://ruralneuropractice.com](https://ruralneuropractice.com) Journal of Neurosciences in Rural Practice Systematic Review Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer: Strength of current evidence Rakesh Kumar Mishra1, Vishal K. Chavda2, Luis Rafael Moscote-Salazar3, Oday Atallah4, Saikat Das5, Tariq Janjua6, Ved Prakash Maurya7, Amit Agrawal5 1Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 2Department of Pathology, Stanford University School of Medicine, Stanford University Medical Center, CA-USA, 3Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, 4Department of Neurosurgery, Hannover Medical School, Hannover, Germany, 5Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, 6Department of Neurology, Regions Hospital, Saint Paul, Minnesota, United States, 7Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. ABSTRACT Objectives: D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. Materials and Methods: We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Metaanalysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. Results: The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001. Conclusion: D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients. Keywords: Cancer, D-dimer, Stroke, Prognosis, Cerebral infarction INTRODUCTION The D-dimer is the fibrin degradation product at minimally detectable levels in normal individuals; however, it increases in stroke patients, thrombolytic/fibrinolytic disorders, and critically sick patients. [1-3] Patients with malignancy are especially prone to develop ischemic stroke by various mechanisms including hypercoagulable state and tumor occlusion. [3-8] Various studies have reported that high plasma D-dimer levels can be seen in cancer-associated ischemic stroke patients, further supporting the assumption that hypercoagulability is a significant risk factor for developing stroke in cancer patients. [2,3,9-13] Studies have shown that abnormal D-dimer levels and multiple territories of infarctsare predictors of malignancy in a stroke patient. [2,1

FAQs

What question does the study aim to answer about D-dimer in stroke patients?

It evaluates whether baseline D-dimer levels in stroke differ between patients with cancer and those without cancer, and how that evidence can support screening for active or occult cancer.

How were included studies identified and assessed for quality?

The review followed PRISMA guidelines, searched multiple databases up to June 2023, used independent iterative steps by two reviewers, and assessed study quality with the Newcastle-Ottawa scale for case-control and cohort studies and AHRQ tools for cross-sectional studies.

What were the main findings regarding baseline D-dimer levels?

Baseline D-dimer levels were significantly higher in stroke patients with cancer than in non-cancer patients, with a mean difference of 4.84 (3.07–6.60) and P < 0.00001.

Sep 21, 2026

Uploaded by Finn