From the Guidelines
Very high D-dimer levels can be caused by several life-threatening conditions, including deep vein thrombosis (DVT), pulmonary embolism (PE), disseminated intravascular coagulation (DIC), and severe COVID-19 infection, which require immediate medical attention. The causes of very high D-dimer levels can be categorized into several groups, including:
- Cardiovascular conditions: DVT, PE, DIC, heart attack, stroke, and aortic dissection 1
- Infectious diseases: severe COVID-19 infection, sepsis 1
- Cancer and malignancy: various types of cancer can increase D-dimer levels 1
- Pregnancy and postpartum state: D-dimer levels can be elevated during pregnancy and postpartum period 1
- Trauma and surgery: recent surgery, extensive trauma can cause high D-dimer levels
- Liver disease: liver disease can lead to high D-dimer levels as the liver is responsible for clearing D-dimer from circulation
- Other conditions: acute mesenteric ischemia, venous thromboembolism, and thrombophilia can also cause elevated D-dimer levels 1
It is essential to note that advanced age naturally increases D-dimer levels, so values must be interpreted in clinical context 1. When a patient presents with an elevated D-dimer, clinicians typically perform additional diagnostic tests such as ultrasound, CT angiography, or ventilation-perfusion scans to identify the underlying cause 1. D-dimer is a fibrin degradation product formed when the body breaks down blood clots, so its elevation indicates active clotting and fibrinolysis somewhere in the body. Very high D-dimer levels (>5000 ng/mL) often indicate serious pathology requiring immediate medical attention 1.
Some key points to consider when evaluating a patient with high D-dimer levels include:
- Clinical presentation: patients with high D-dimer levels may present with symptoms such as chest pain, shortness of breath, or abdominal pain
- Laboratory results: D-dimer levels, complete blood count, blood chemistry, and other relevant laboratory tests
- Imaging studies: ultrasound, CT angiography, or ventilation-perfusion scans to identify the underlying cause
- Risk factors: patients with a history of cardiovascular disease, cancer, or other conditions that increase the risk of thrombosis should be evaluated carefully.
In summary, very high D-dimer levels can be caused by several life-threatening conditions, and it is essential to evaluate patients carefully and perform additional diagnostic tests to identify the underlying cause.
From the Research
Causes of Very High D-Dimer
- Very high D-dimer levels are associated with severe disease, mainly including venous thromboembolism (VTE), sepsis, and/or cancer 2
- Pulmonary embolism is a common cause of very high D-dimer levels, with a prevalence of 32% in patients with extremely elevated D-dimer results 2
- Other causes of very high D-dimer levels include:
- High D-dimer levels increase the likelihood of pulmonary embolism, with a fourfold increase in prevalence when D-dimer levels are greater than 4000 ng/mL compared to levels between 500 and 1000 ng/mL 3
- D-dimer levels can also be elevated in other conditions, such as disseminated intravascular coagulation (DIC) and intracranial hemorrhage 4, 5
Diagnostic Considerations
- D-dimer testing is a valuable tool for diagnosing VTE and pulmonary embolism, but its interpretation requires caution 4, 6
- The intended use of D-dimer tests depends on the assay used, and local guidance should be applied 6
- D-dimer testing may suffer from diagnostic errors occurring throughout the pre-analytical, analytical, and post-analytical phases of the testing process 6