Elevated levels of D-dimers increase the risk of ischaemic and haemorrhagic stroke: Findings from the EPICOR Study

Augusto Di Castelnuovo, Claudia Agnoli, Amalia de Curtis, Maria Concetta Giurdanella, Sabina Sieri, Amalia Mattiello, Giuseppe Matullo, Salvatore Panico, Carlotta Sacerdote, Rosario Tumino, Paolo Vineis, Giovanni de Gaetano, Maria Benedetta Donati, Licia Iacoviello

Research output: Contribution to journalArticlepeer-review


Elevated D-dimer levels are reportedly associated with coronary artery disease. It was the study objective to investigate the association of baseline D-dimer levels with strokes that occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Using a nested case-cohort design, a centre-–stratified sample of 832 subjects (66 % women, age 35–71) was selected as subcohort and compared with 289 strokes in a mean follow-up of nine years. D-dimers were measured by an automated latex-enhanced immunoassay (HemosIL-IL). The multivariable hazard ratios were estimated by a Cox regression model using Prentice method. Individuals with elevated D-dimer levels had significantly higher risk of incident stroke. It was evident from the second quartile (D-dimers > 100 ng/ml) and persisted almost unchanged for higher D-dimers (hazard ratio [HR] 2.10, 95 % confidence interval [CI]: 1.28–3.47; 2.42, 95 %CI: 1.44–4.09 and 2.10, 95 %CI: 1.27–3.48 for the second, third or fourth quartile compared with the lowest quartile, respectively). The association was independent of several confounders, including triglycerides and C-reactive protein. No differences were observed in men and women (P for interaction= 0.46), in hypertensive or non-hypertensive subjects (P for interaction= 0.88) or in subjects with low (<1 mg/l) or elevated (≥ 1 mg/l) C-reactive protein (P for interaction=0.35). After stratification for stroke type, the hazard ratio for every standard deviation increase was statistically significant both for ischaemic (1.21; 95 %CI: 1.01 to 1.45) and haemorrhagic (1.24; 95 %CI: 1.00 to 1.65) strokes. In conclusion, our data provide clear evidence that elevated levels of D-dimers are potential risk factors not only for ischaemic but also for haemorrhagic strokes.

Original languageEnglish
Pages (from-to)941-946
Number of pages6
JournalThrombosis and Haemostasis
Issue number5
Publication statusPublished - 2014


  • Cerebrovascular disease
  • Coagulation factors
  • Epidemiological studies
  • Risk factors
  • Stroke / prevention

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)


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