Which condition is associated with an elevated serum D-dimer (D-dimer) assay: alcohol use, cocaine use, sickle cell trait, warfarin (coumarin) use, or white race?

From the Guidelines

An elevated serum D-dimer assay is most strongly associated with warfarin (coumadin) use among the options listed. Warfarin is an anticoagulant medication that inhibits vitamin K-dependent clotting factors, which alters the coagulation cascade and can lead to increased fibrinolysis. D-dimer is a fibrin degradation product that forms when cross-linked fibrin is broken down by plasmin during fibrinolysis. When patients are on warfarin therapy, there is often increased fibrinolytic activity as the body attempts to maintain hemostatic balance, resulting in elevated D-dimer levels. This is particularly true during the initial phases of warfarin therapy before a stable anticoagulant effect is achieved. It's essential to consider the limitations and variability of D-dimer assays, as highlighted in recent studies 1, which emphasize the need for accurate reporting and standardization of D-dimer measurements.

Some key points to consider when interpreting D-dimer results include:

• The type of D-dimer assay used and its analytical performance
• The units of measurement and any age-related cutoffs
• The distinction between thromboembolism and disseminated intravascular coagulation (DIC)
• The potential for interference from other conditions, such as sepsis or inflammation
• The importance of considering the patient's clinical presentation and other diagnostic factors alongside D-dimer results.

While warfarin can cause elevated D-dimer levels, many other conditions can also increase D-dimer, including deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, and recent surgery. Therefore, clinicians should approach D-dimer results with caution and consider the broader clinical context when making diagnostic and treatment decisions.

From the Research

Conditions Associated with Elevated Serum D-dimer Assay

The following conditions or factors are associated with an elevated serum D-dimer assay:

• Cocaine use: Studies have shown that cocaine use can lead to increased plasma von Willebrand factor, accelerated atherosclerosis, and platelet-rich arterial thrombi, suggesting that cocaine activates the endothelium, promoting platelet-VWF interactions 2. Additionally, cocaine use has been identified as a significant positive predictor of D-dimer positive results 3.
• Sickle cell trait: While sickle cell trait itself may not be directly associated with elevated D-dimer levels, sickle cell disease has been linked to positive D-dimer results 3.
• Warfarin use is actually protective against elevated D-dimer levels, rather than being a cause 3.
• Other factors such as increasing age, black race, general or limb immobility, hemoptysis, hemodialysis, active malignancy, and prior venous thromboembolism can also contribute to elevated D-dimer levels 3.

Factors Not Directly Associated with Elevated D-dimer

The following factors are not directly associated with elevated D-dimer levels:

• Alcohol use: There is no direct evidence in the provided studies linking alcohol use to elevated D-dimer levels.
• White race: While race can be a factor in D-dimer results, with black race being associated with positive D-dimer results, white race is not directly linked to elevated D-dimer levels 3.