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What is D-Dimer?

It is a marker of blood clotting activity.

How is the D-Dimer measured?

There are many different D-Dimer assays (qualitative and quantitative) available.

Different types of assay are not standardised and have varying sensitivities and specificities. Furthermore, different laboratories may use different ‘cut-offs’ for what constitutes a positive or negative result. Check your local institutions guidelines. Most contemporary laboratories use high sensitivity assays.

D-dimer can be reported as fibrinogen equivalent units (FEU) or d-dimer units (DDU). One DDU = 2 FEU. The reporting units used will affect the cut-off. The standard cut-off for venous thromboembolism is 0.5mg/L FEU or 0.25mg/L DDU.

When can the D-Dimer be positive?

Acute coronary syndromesAge (healthy elderly people)
Acute upper gastrointestinal haemorrhageCigarette smoking
Aortic dissectionPost-operatively
Arterial or venous thromboembolismPregnancy
Atrial fibrillation 
Consumptive coagulopathy – DIC, VICC 
Sickle cell disease 
Superficial thrombophlebitis 

When is the D-Dimer indicated in Emergency?

1. As part of a probability assessment when DVT or PE is suspected

2. To help diagnose fibrinolytic disorders such as venom-induced consumptive coagulopathy (VICC) and disseminated intravascular coagulation (DIC)

How can I use it in suspected PE?

  • First a pre-test probability of PE should be calculated. For example Wells criteria / revised Geneva score.

  • There are three tier models using low, intermediate and high probabilities, or two tier models ( now more accepted) using PE likely and PE unlikely.

  • If using a moderately sensitive assay then a D-Dimer should ONLY be used for patients with a LOW pre-test probability.

  • If it is a high sensitivity assay then it can be used in both low and intermediate probability patients, and PE unlikely patients.

  • In these patients if the D-Dimer is negative (i.e. less than the 'cut-off' value) a PE can be excluded.No further investigations.

  • If the D-Dimer test is positive further investigation is usually required such as CTPA or VQ scan.

  • Click here for a link to the British Thoracic Society for use of D-Dimer.

How do I use it in suspected DVT?

  • First a pre-test probability for DVT should be calculated using the WELLS score for DVT.

  • In patients with a LOW pre-test probability (unlikely DVT) a D-Dimer test is appropriate.

  • In this cohort if the D-Dimer is negative a DVT can be excluded. If positive then further investigation is required.

  • In patients with a HIGH pre-test probability (likely DVT) a D-Dimer is not appropriate. Patients should undergo further imaging to exclude a DVT.

Age-adjusted D-dimer

  • Clinicians should use age-adjusted D-dimer thresholds in patients older than 50 years of age to determine whether imaging is required.
  • Positive D-dimer result:
  • : D-dimer >0.5mg/L
  • >50 years: D-dimer >(age x 0.01mg/L)
  • For example 60 years: D-dimer >60 x 0.01mg/L = 0.6mg/L

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