Lab Med Online.  2012 Jul;2(3):119-125.

D-Dimer Testing in Laboratory Practice

• Tripodi A

Abstract

BACKGROUND
D-dimer is a reliable and sensitive index of fibrin deposition and stabilization. As such, its presence in plasma should be indicative of thrombus formation. There are many conditions unrelated to thrombosis in which D-dimer concentrations are high, however, making its positive predictive value rather poor. CONTENT: Notwithstanding these limitations, D-dimer can be regarded as a most valuable laboratory tool to diagnose and manage a vast array of thrombosis related clinical conditions, including (a) diagnosis of venous thromboembolism (VTE), (b) identification of individuals at increased risk of first thrombotic event (both arterial and venous), (c) identification of individuals at increased risk of recurrent VTE, (d) establishment of the optimal duration of secondary prophylaxis after a first episode of VTE, (e) pregnancy monitoring, and (f) diagnosis/monitoring of disseminated intravascular coagulation (DIC). This article is aimed at reviewing the merits and pitfalls of these applications. SUMMARY: From my analysis of the literature, I draw the following conclusions. (a) D-dimer, as measured by a sensitive test, can be safely used to exclude VTE in symptomatic outpatients, provided that it is used in combination with the pretest clinical probability. (b) High concentrations of D-dimer are associated with an increased risk of recurrent VTE. (c) Patients who present with D-dimer above cutoff after stopping the regular course of oral anticoagulation benefit from extended prophylaxis. (d) Finally, D-dimer can be used as a fibrin-related degradation marker for the diagnosis/management of patients with DIC.

Keyword

D-dimer; Venous thromboembolism; Disseminated intravascular coagulation

MeSH Terms

Dacarbazine
Disseminated Intravascular Coagulation
Fibrin
Fibrin Fibrinogen Degradation Products
Humans
Outpatients
Plasma
Pregnancy
Thrombosis
Venous Thromboembolism
Dacarbazine
Fibrin
Fibrin Fibrinogen Degradation Products

Figure

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  Fig. 1 D-dimer concentrations measured in plasma from patients with and without PE. The horizontal bold line represents the cutoff value. Reproduced from Bounameaux et al. [11] with the permission of the publisher.

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  Fig. 2 Algorithm for the diagnosis of VTE describing the usefulness of D-dimer testing in combination with pretest clinical probability. This algorithm can be applied to symptomatic outpatients.

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