An engaging review reveals that D-dimer, which is a simple and relatively non-expensive biomarker 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. This has been seen in the Journal of Neurosciences in Rural Practice published by Scientific Scholar. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer.

The authors conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles. 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.

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 patients had active cancer while 2247 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.

Hence it was concluded that 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. Medical Dialogues team interacted with the lead author of the study, Dr. Rakesh Kumar Mishra from the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University,

Varanasi, Uttar Pradesh, India who provided insights on the following-
1. The biological significance of D-dimer? 

2. How the normal levels of D-dimer fluctuate among Cardiac and Onco patients? 

3. What led to this multi-institutional and cross-country authored meta-analysis and what is the therapeutic significance of the study? 

4. Developing on the current analysis, are there any future studies planned on similar lines? 

5. Two words for Journal of Neuroscience in Rural Practice, your experience with publishing in this journal?