D-dimer testing in cardiovascular disease: Laboratory and clinical pitfalls

Area of Science:

• Clinical Chemistry
• Hematology
• Cardiovascular Medicine

Background:

• D-dimer, a fibrin degradation product, is a widely used biomarker for coagulation activation and fibrinolysis.
• Interpretation challenges include lack of international standards, assay harmonization issues, preanalytical variables, and antibody interference.
• Variability exists between different D-dimer assays due to monoclonal antibody reactivity.

Purpose of the Study:

• To summarize laboratory and clinical knowledge on D-dimer measurement and interpretation.
• To focus on the role of D-dimer in acute and chronic cardiovascular diseases.
• To highlight the clinical utility and limitations of D-dimer testing.

Main Methods:

• Review of laboratory and clinical data on D-dimer.
• Analysis of factors affecting D-dimer assay results.
• Evaluation of D-dimer's role in various clinical conditions, particularly cardiovascular diseases.

Main Results:

• D-dimer is a well-established biomarker for coagulation activation and fibrinolysis.
• Age-adjusted D-dimer has a high negative predictive value for venous thromboembolism (pulmonary embolism, deep-vein thrombosis).
• Elevated D-dimer levels are associated with numerous conditions, including cardiovascular diseases, infection, cancer, and pregnancy, but are not a sole indication for anticoagulation.

Conclusions:

• D-dimer measurement and interpretation require careful consideration of assay-specific factors and clinical context.
• While valuable for ruling out venous thromboembolism, elevated D-dimer necessitates further investigation to determine underlying causes.
• Understanding D-dimer's role in cardiovascular diseases is crucial for accurate patient management.