D-dimer - diagnostic and prognostic marker of venous thromboembolism

Abstract

D-dimer (DD), the final degradation product of cross-linked fibrin, is typically elevated in patients with acute venous thromboembolism (VTE). An elevated DD is associated with many illnesses, and therefore, is not specific for VTE. With its high sensitivity and negative predictive value, DD testing has an established role for ruling-out the diagnosis in patients with suspected deep vein thrombosis or pulmonary embolism and low pretest clinical probability. Recent publications indicate that DD testing may be also helpful in stratifying patients into higher and lower risks groups for VTE recurrence after anticoagulant discontinuation. A large variety of assays are now available for DD measurement with different sensitivities and specificities for the diagnosis of VTE. The main limitation of DD testing is a reduced usefulness in specific patient categories or clinical settings like in elderly or cancer patients, in patients with previous VTE or after surgery, and in pregnant and postpartum women.