From the Guidelines
Elevated D-dimer levels are primarily caused by conditions involving abnormal blood clot formation or breakdown, and treatment focuses on addressing the underlying cause rather than the D-dimer level itself. The causes of high D-dimer levels include deep vein thrombosis (DVT), pulmonary embolism (PE), disseminated intravascular coagulation (DIC), recent surgery, pregnancy, cancer, infections, and inflammatory conditions 1. D-dimer levels can also rise with age, during pregnancy, and after trauma. For thrombotic conditions like DVT or PE, anticoagulation therapy is typically prescribed, starting with heparin (unfractionated or low-molecular-weight such as enoxaparin 1mg/kg twice daily) or fondaparinux, followed by oral anticoagulants like warfarin (target INR 2-3), or direct oral anticoagulants (DOACs) such as apixaban (5mg twice daily), rivaroxaban (15-20mg daily), or dabigatran (150mg twice daily) 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. It's essential to understand that D-dimer is primarily a screening tool with high sensitivity but low specificity, making it valuable for ruling out thrombotic conditions when negative but requiring further diagnostic testing when elevated 1. Some key points to consider in the management of elevated D-dimer levels include:
- The use of D-dimer assays to rule out PE or DVT in patients with low clinical probability 1
- The importance of clinical probability assessment in conjunction with D-dimer testing 1
- The role of anticoagulation therapy in the treatment of thrombotic conditions 1
- The need for further diagnostic testing in patients with elevated D-dimer levels 1
- The use of prophylactic dose low molecular weight heparin in patients with COVID-19 and elevated D-dimer levels 1
From the Research
Causes of Elevated D-Dimer Levels
- 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 are uniquely associated with severe disease, mainly including VTE, sepsis, and/or cancer 3
- D-dimer levels can be elevated in patients with peripheral arterial disease, and are linked with thrombotic events in patients with venous as well as arterial thrombosis 4
- Other causes of elevated D-dimer levels include trauma, surgery, and cardiopulmonary resuscitation 3
Treatment Options for Elevated D-Dimer Levels
- Antithrombotic therapy may be warranted in patients with elevated D-dimer levels, particularly in those with a high risk of VTE 2
- Once-daily subcutaneous enoxaparin in the outpatient setting is at least as effective and as well tolerated as in-hospital intravenous unfractionated heparin for treatment of deep-vein thrombosis 5
- Rivaroxaban may reduce the sensitivity and increase false negative results of D-dimer testing, and it is recommended to perform D-dimer testing before administering rivaroxaban 6
- Treatment of underlying conditions such as sepsis, cancer, and peripheral arterial disease may also be necessary to reduce D-dimer levels and prevent thrombotic events 3, 4