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Plasma D-dimer concentrations in different clinical conditions
K Ver Elst1, K Jochmans, A De Pauw
1Laboratorium Hematologie en Hemostase, Academisch Ziekenhuis Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, België.
Insights
D-dimer (DD) testing is frequently positive in various conditions beyond blood clots. Elevated DD levels occur in many diseases and physiological states, not just deep venous thrombosis or pulmonary embolism.
Area of Science:
- Biochemistry
- Hematology
- Clinical Pathology
Background:
- D-dimers (DD) are markers of fibrinolysis and coagulation activation.
- Low DD levels effectively rule out deep venous thrombosis (DVT) and pulmonary embolism (PE).
- Positive DD results are observed in numerous diseases and physiological conditions, including advanced age and pregnancy.
Purpose of the Study:
- To demonstrate the prevalence of positive D-dimer (DD) results in diverse medical conditions and physiological states.
- To investigate variations in DD positivity across different pathological conditions.
- To assess the clinical utility and physician request patterns for DD testing.
Main Methods:
- Retrospective analysis of medical records for 574 consecutive patients (outpatients and inpatients).
- Examination of plasma D-dimer (DD) concentrations and associated clinical diagnoses.
- Evaluation of clinician request attitudes and understanding of DD test relevance.
Main Results:
- Overall D-dimer (DD) positivity rate was 64%, with a median concentration of 775 µg/L.
- Elevated DD concentrations were observed across a wide spectrum of clinical conditions.
- Clinician requests for DD testing were often frequent and not always clinically relevant, indicating potential misunderstanding of results.
Conclusions:
- Positive D-dimer (DD) results are common in various diseases and physiological conditions, extending beyond thromboembolic events.
- The clinical interpretation and relevance of positive DD results require careful consideration within the patient's overall clinical context.
- Optimizing the appropriate use of DD testing is crucial to avoid unnecessary confusion and ensure clinical relevance.
Abstract:
D-dimers (DD), specific degradation products of crosslinked fibrin, are markers for activation of plasma coagulation and/or fibrinolysis. DD results below the cut-off level are proven to be useful to rule out the probable diagnosis of deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Our objective was to demonstrate that positive DD occur in many diseases and certain physiological conditions as high age and pregnancy and to look for gradations in positivity between different pathological conditions. We wanted to investigate the request attitude of our clinicians concerning DD. Positive DD results still confuse some physicians. Retrospectively, we examined medical records of 574 consecutive patients, in whom plasma DD were measured in daily routine. Both outpatients (n = 423) and inpatients (n = 151) were included. We noted their clinically predominant disease. Measurement of DD concentration is too often requested by clinicians, in any medical condition, and is not always clinically relevant. The relation of a positive result and the clinical problem is sometimes not understood. Overall, we found 64% DD positivity with a median concentration of 775 micrograms/L. We found elevated DD concentrations in various clinical conditions.