D-Dimer Testing in Laboratory Practice*

Armando Tripodi

doi:10.3343/lmo.2012.2.3.119

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Tripodi: D-Dimer Testing in Laboratory Practice*

Translation

Diagnostic Hematology

Laboratory Medicine Online

Laboratory Medicine Online 2012; 2(3): 119-125.

Published online: 1 July 2012

DOI: https://doi.org/10.3343/lmo.2012.2.3.119

D-Dimer Testing in Laboratory Practice^*

Armando Tripodi

Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University of IRCCS and Mangiagalli, Milan, Italy.

Translators: Mi Young Park, In Suk Kim. Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea. (iskim0710@gmail.com). This article is translated from an English language article, originally published in Clinical Chemistry under agreement between the publishers of Laboratory Medicine Online and Clinical Chemistry. Acknowledgement and other information that is not directly related to the content of the article has not been translated, and thus omitted in this article. References are listed as they were in the original work. Original copyright © 2011 American Association for Clinical Chemistry, Inc.

Received 31 January 2012 Revised 31 January 2012 Accepted 3 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: D-dimer, Venous thromboembolism, Disseminated intravascular coagulation

Figures and Tables

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.

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.

Table 1

Conditions characterized by increased D-dimer concentrations

Table 2

Pretest clinical probability score^*

^*Modified from Wells [13]; ^†Probability of deep vein thrombosis: <1, low; 1-2, moderate; >2, high; ^‡Probability of pulmonary embolism: <2, low; 2-6, moderate; >6, high.

Table 3

Considerations in the choice of a D-dimer test

Table 4

Limitations on the use of D-dimer for VTE diagnosis

Notes

This article is available from http://www.labmedonline.org

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