From the Guidelines
Elevated D-dimer levels are primarily caused by conditions involving abnormal blood clot formation or breakdown, and treatment should focus on addressing the underlying cause rather than the D-dimer level itself, with anticoagulation therapy being a common approach for thrombotic conditions like DVT or PE, as recommended by the 2020 guidelines from the American Society of Hematology 1.
Causes of Elevated D-dimer Levels
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
- Disseminated intravascular coagulation (DIC)
- Recent surgery
- Pregnancy
- Cancer
- Infections
- Inflammatory conditions
- Age
- Trauma
Treatment Options
- Anticoagulation therapy for thrombotic conditions like DVT or PE, starting with heparin (unfractionated at 80 units/kg bolus followed by 18 units/kg/hour infusion, or low molecular weight heparin like enoxaparin at 1 mg/kg twice daily) and transitioning to oral anticoagulants such as warfarin (target INR 2-3) or direct oral anticoagulants (DOACs) like apixaban (5 mg twice daily) or rivaroxaban (15-20 mg daily with food) 1
- Treatment duration ranges from 3-6 months for provoked clots to indefinite therapy for unprovoked or recurrent events
- For DIC, treating the underlying condition and providing supportive care with blood products is essential
- In inflammatory conditions, addressing the inflammation with appropriate medications may normalize D-dimer levels
Diagnostic Considerations
- D-dimer testing has a high negative predictive value, but a low positive predictive value, and is not useful for confirmation of PE 1
- D-dimer levels can be elevated in patients with cancer, hospitalized patients, severe infection or inflammatory disease, and during pregnancy 1
- Imaging studies, such as ultrasound, may be necessary to definitively exclude DVT and properly document the extent of venous thrombosis 1
From the Research
Causes of Elevated D-Dimer
- Elevated D-dimer levels are associated with an increased risk of incident venous thromboembolism (VTE), recurrent VTE, and mortality 2
- Extremely elevated D-dimer levels (> 5000 μg/l) are specific for serious illness, including VTE, sepsis, and cancer 3
- D-dimer may be high due to physiologic conditions, such as aging, pregnancy, and strenuous physical activity 4
- Several disorders have been associated with increased D-dimer levels, ranging from disseminated intravascular coagulation to infectious diseases and cancers 4, 5
Treatment Options for Elevated D-Dimer
- Anticoagulation is the foundation of treatment for patients with venous thromboembolism (VTE) 6
- Patients with pulmonary embolism should undergo risk stratification to establish whether they will benefit from the addition of advanced treatment, such as thrombolysis or embolectomy 6
- Novel oral anticoagulant drugs are in development, which could replace vitamin K antagonists and heparins in many patients 6
- The management of patients with increased D-dimer without signs or symptoms of thrombus formation should be done by a hematologist, who can evaluate the efficacy and safety of antithrombotic therapy 2, 4