Association of D-Dimer and Fibrinogen Levels with Stroke Severity in Acute Ischemic Stroke Patients: A Cross-Sectional Study at a Tertiary Referral Hospital in Indonesia

Why It Matters

The ability to gauge stroke severity quickly using routine blood tests can improve triage and treatment decisions, especially in resource‑limited settings. Incorporating D‑dimer and fibrinogen into protocols may enhance prognostic accuracy and guide therapeutic interventions.

Key Takeaways

• Severe strokes show D‑dimer ~3× higher than moderate
• Fibrinogen levels rise significantly with stroke severity
• D‑dimer correlates stronger with NIHSS than fibrinogen
• Biomarkers could aid early risk stratification in Indonesian hospitals
• Larger multicenter studies needed to confirm prognostic utility

Pulse Analysis

Acute ischemic stroke remains a leading cause of death and disability worldwide, and timely assessment of severity is critical for directing acute therapies such as thrombolysis or mechanical thrombectomy. While neuroimaging provides definitive information, it is often unavailable or delayed in low‑resource hospitals. Consequently, clinicians have turned to laboratory markers that reflect the underlying hypercoagulable state, with D‑dimer and fibrinogen emerging as inexpensive, widely accessible indicators of clot formation and fibrinolysis. Understanding how these biomarkers map onto clinical severity can fill a diagnostic gap in many settings.

The Indonesian cross‑sectional study of 69 patients demonstrated that both D‑dimer and fibrinogen levels rise markedly with worsening stroke, but D‑dimer showed a three‑fold increase in severe cases and a stronger correlation with NIH Stroke Scale scores. This pattern aligns with prior research linking elevated D‑dimer to larger infarct volumes and poorer outcomes, suggesting that the test captures not only clot burden but also systemic inflammatory responses. For hospitals like Haji Adam Malik General, incorporating a single D‑dimer measurement on admission could streamline risk stratification without adding significant cost.

Despite promising results, the single‑center design and modest sample size limit generalizability, underscoring the need for multicenter, longitudinal trials that track long‑term functional recovery and mortality. Future investigations should also explore whether serial measurements can predict hemorrhagic transformation or guide anticoagulation intensity. If validated, integrating D‑dimer and fibrinogen into stroke pathways could enhance decision‑making, reduce unnecessary imaging, and ultimately improve outcomes across diverse healthcare systems. The study thus adds a valuable piece to the evolving puzzle of biomarker‑driven stroke care.