D-dimer

Last revised by Arlene Campos on 7 Jun 2024

D-dimer is a commonly tested biological marker which is produced by the enzymatic breakdown of cross-linked fibrin which forms the fibrous mesh of a blood clot. The measurement of D-dimer in the circulation acts as a marker of coagulation and fibrinolysis, which can be useful in the diagnosis of multiple diseases.

Validated uses of D-dimer
Unvalidated uses of D-dimer
  • predicting the risk of stroke in patients with atrial fibrillation

  • ruling out aortic dissection in low-risk patients (ADD-RS plus D-dimer)

  • helping predict cardiovascular risk in HIV infected patients

  • some case reports suggest that COVID-19 vaccines could increase blood clotting in some predisposed subjects, as can be seen from the alteration of the D-dimer level 12,13

  • potential marker of clotting in Long COVID-19 patients 14

Conditions associated with a raised D-dimer
Conditions associated with an extremely high D-Dimer

In a large study in 2016 an extreme elevated level was arbitrarily defined as >5,000 µg/L FEU 4. An older study from 2011, defined an extreme elevated D-dimer as >50,000 µg/L FEU 9. A study series of adult-onset Still disease only, found very high D-dimers in four of 22 patients, defined in this case as >5,000 µg/L FEU 11.

The vast majority of cases were associated with severe disease:

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