From the Guidelines
D-dimer elevation is primarily caused by conditions that activate the coagulation cascade, leading to fibrin clot formation and subsequent breakdown, with common causes including venous thromboembolism, sepsis, disseminated intravascular coagulation, malignancies, recent trauma or surgery, and acute myocardial infarction. These conditions can lead to increased levels of D-dimer in the blood, as noted in the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1. Some of the key causes of D-dimer elevation include:
- Venous thromboembolism, such as deep vein thrombosis or pulmonary embolism
- Sepsis or severe infection
- Disseminated intravascular coagulation
- Malignancies, such as cancer
- Recent trauma or surgery
- Acute myocardial infarction
- Acute aortic dissection, as significant elevations of D-dimer were seen in all 24 patients with documented acute aortic dissection involving either the ascending or descending thoracic aorta, regardless of time from presentation 1. It is essential to note that D-dimer levels can be elevated in various conditions, and a negative D-dimer result does not entirely rule out the presence of a thrombotic disorder, especially in high-risk individuals 1.
From the Research
Causes of D-Dimer Elevation
- D-dimer elevation can be caused by various conditions, including:
- Elevated D-dimer levels can also be associated with increased mortality and underlying malignancy in the absence of VTE 4
- D-dimer levels can be influenced by various factors, including age, pregnancy, renal function, and cancer 6
Conditions Associated with D-Dimer Elevation
- VTE: D-dimer testing is commonly used in the diagnosis of VTE, and elevated levels can indicate the presence of a blood clot 2, 3
- Cancer: High D-dimer levels have been associated with an increased incidence of malignancy, particularly in breast, prostate, and bowel cancers 4
- Sepsis: Elevated D-dimer levels can be seen in patients with sepsis, and may indicate a poor prognosis 2
- Trauma/surgery: D-dimer levels can be elevated in patients who have undergone trauma or surgery, and may indicate an increased risk of VTE 2
Clinical Significance of D-Dimer Elevation
- Elevated D-dimer levels can indicate the presence of a serious underlying condition, and may require further investigation and treatment 2, 4
- D-dimer testing can be used to exclude VTE in patients with a low pretest probability, and to avoid unnecessary imaging tests 3, 6
- D-dimer levels can be used to predict clinical severity and mortality in patients with COVID-19, and to guide anticoagulation therapy 6