From the Guidelines
Elevated D-dimer levels can be caused by various conditions, including deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, recent surgery, pregnancy, cancer, severe infections, and inflammatory conditions, as well as trauma, heart attacks, and strokes, as noted in the 2020 European Heart Journal guidelines 1. The most common causes of elevated D-dimer levels include:
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
- Disseminated intravascular coagulation (DIC)
- Recent surgery
- Pregnancy
- Cancer
- Severe infections
- Inflammatory conditions
- Trauma
- Heart attacks
- Strokes It's also important to note that normal aging naturally increases D-dimer levels, which is why age-adjusted cutoffs are often used in clinical practice, and COVID-19 infection has also been associated with elevated D-dimer levels, particularly in severe cases, as mentioned in the context of coagulation and fibrinolysis activity in the body 1. D-dimer is a fibrin degradation product formed when plasmin breaks down cross-linked fibrin in blood clots, making it a marker of both coagulation and fibrinolysis activity in the body, and while it is sensitive for ruling out thrombotic conditions when negative, a positive result requires further diagnostic testing as it lacks specificity, as highlighted in the 2010 Circulation guidelines 1 and further emphasized in the 2020 European Heart Journal guidelines 1. The use of D-dimer assays can help identify patients who do not require definitive imaging studies, but the efficacy and safety of this strategy have not been tested in a large clinical trial, and several caveats should apply, including the limitation of clinical scoring systems to identify the true pretest probability for AoD in individual patients, as noted in the 2010 Circulation guidelines 1.
From the Research
Causes of Elevated D-Dimer
Elevated D-dimer levels can be caused by various conditions, including:
- Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) 2, 3, 4
- Sepsis 2
- Cancer 2
- Trauma or surgery 2
- Disseminated intravascular coagulation (DIC) 3
- Intracranial hemorrhage and gastrointestinal (GI) bleed 3
- COVID-19 5
Conditions Associated with Increased D-Dimer Levels
D-dimer levels can be increased in various conditions, including:
- Venous thromboembolism (VTE) 2, 3, 4, 5
- Sepsis 2
- Cancer 2
- Trauma or surgery 2
- DIC 3
- Intracranial hemorrhage and gastrointestinal (GI) bleed 3
- COVID-19 5
- Aging 5
- Pregnancy 5
- Renal function impairment 5
Diagnostic Value of D-Dimer
D-dimer testing is commonly used to rule out VTE, including DVT and PE, especially when combined with a clinical pretest probability assessment 6, 4, 5. However, D-dimer testing may suffer from diagnostic errors, and its interpretation requires caution 3, 6.