How to use D-dimer in acute cardiovascular care

Abstract

D-dimer testing is important to aid in the exclusion of venous thromboembolic events (VTEs), including deep venous thrombosis and pulmonary embolism, and it may be used to evaluate suspected aortic dissection. D-dimer is produced upon activation of the coagulation system with the generation and subsequent degradation of cross-linked fibrin by plasmin. Many different assays for D-dimer testing are currently used in routine care. However, these tests are neither standardized nor harmonized. Consequently, only clinically validated assays and assay specific decision limits should be used for routine testing. For the exclusion of pulmonary embolism/deep vein thrombosis, age-adjusted cut-offs are recommend. Clinicians must be aware of the validated use of their hospital's D-dimer assay to avoid inappropriate use of this biomarker in routine care.

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

“…D‐dimer elevation may be seen in conditions in which fibrin is formed and then broken down, including such conditions as recent surgery, arrhythmia, pregnancy, trauma, infection, heart attack, and some cancers or conditions in which fibrin is not cleared normally, such as liver cirrhosis 5. The behavior of D‐dimer should be understood when the data are being interpreted.…”

“…The serum D‐dimer concentration has been reported to increase within 6 hours after the onset of aortic dissection and to peak within 24 hours 20, 33. D‐dimer has a half‐life of ≈8 hours 5. Although the sensitivity of D‐dimer testing remains high at 95.3% up to 10 days after the onset of AAD,34 delayed hospital arrival may influence the D‐dimer concentration, possibly obscuring the telltale elevation.…”

“…The study was conducted at a single center in a retrospective manner. In addition, the monoclonal antibody used in a D‐dimer assay recognizes a specific epitope on the D‐dimer fragment, but there are >20 different monoclonal antibodies used for 30 different D‐dimer assays 5. Furthermore, antibodies have different analytical sensitivities and specificities 5.…”

“…In addition, the monoclonal antibody used in a D‐dimer assay recognizes a specific epitope on the D‐dimer fragment, but there are >20 different monoclonal antibodies used for 30 different D‐dimer assays 5. Furthermore, antibodies have different analytical sensitivities and specificities 5. Although we used 8.3 μg/mL as a cutoff for the low/relatively high D‐dimer concentration, on the basis of previous studies and on the distribution among our patients, lack of standardization of D‐dimer assay could have led to selection bias.…”

“…D‐dimer is a fibrin fragment, and its elevation is induced by the coagulation cascade and associated with fibrinolysis 3. D‐dimer is now commonly measured not only following fibrinolytic therapy but also in the diagnosis of various diseases, including pulmonary embolism, disseminated intravascular coagulation, sepsis, malignancy, and acute myocardial infarction 4, 5. The utility of D‐dimer assessment in the diagnosis of acute aortic syndrome, including AAD, is well recognized 6, 7, 8, 9, 10.…”