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D-dimers: a most misunderstood test

Luke Carter-Brzezinski1, Scott Houston1,2, Jecko Thachil1,2

  • 1Department of Haematology, Manchester University Hospitals, Manchester, UK.

British Journal of Hospital Medicine (London, England : 2005)
|August 25, 2021
PubMed

Insights

D-dimer testing is validated for excluding venous thromboembolism but is increasingly used for diagnosis and guiding COVID-19 treatment. This review examines the appropriateness of D-dimer use in these varied clinical scenarios.

Area of Science:

  • Clinical diagnostics
  • Hematology
  • Thrombosis research

Background:

  • D-dimer testing is a standard tool in managing venous thromboembolism (VTE).
  • Its established role is in excluding VTE, particularly in emergency settings.
  • Recent trends show increased use for diagnosing VTE and guiding COVID-19 treatment.

Purpose of the Study:

  • To review the established and evolving applications of D-dimer testing.
  • To assess the appropriateness of D-dimer use in diagnosing VTE.
  • To evaluate the role of D-dimers in COVID-19 management strategies.

Main Methods:

  • Literature review of studies on D-dimer utility in VTE and COVID-19.
  • Analysis of clinical guidelines and research pertaining to D-dimer interpretation.
  • Synthesis of evidence regarding D-dimer performance in different patient cohorts.

Main Results:

  • D-dimer assays are highly sensitive for VTE exclusion.
  • Their specificity is limited, leading to potential overdiagnosis when used for definitive diagnosis.
  • In COVID-19, D-dimer levels correlate with disease severity and prognosis, but their role in guiding treatment requires further clarification.

Conclusions:

  • D-dimer testing remains valuable for ruling out VTE in appropriate clinical contexts.
  • Careful interpretation is crucial when using D-dimers for VTE diagnosis due to specificity limitations.
  • The utility of D-dimers in guiding COVID-19 treatment pathways needs further investigation and validation.

Keywords:
AnticoagulationCOVID-19D-dimerFibrinogenThromboembolism

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