Can thrombosis of the dorsal veins of the penis cause elevated D-dimer (D-dimer) levels?

Thrombosis of Dorsal Veins of the Penis and D-dimer Elevation

Yes, thrombosis of the dorsal veins of the shaft of the penis can cause elevated D-dimer levels, as D-dimer is a biomarker that indicates the presence of fibrin degradation products from any thrombotic process in the body. 1

Understanding D-dimer as a Biomarker

• D-dimer is a fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism, making it a marker of both coagulation activation and fibrinolysis 1
• It is generated when crosslinked fibrin (present in blood clots) is broken down by plasmin, making it specific to the presence of thrombus formation and subsequent degradation 1
• D-dimer has a relatively long half-life in circulation (approximately 16 hours), which makes it detectable even after the initial thrombotic event 1

Relationship Between Venous Thrombosis and D-dimer

• Any venous thrombosis, regardless of location, can lead to elevated D-dimer levels as the clot undergoes natural fibrinolysis 2
• D-dimer is highly sensitive to the presence of intravascular thrombus, making it a valuable marker for detecting thrombotic events throughout the body 3
• The dorsal veins of the penis, when thrombosed, would undergo the same pathophysiological process of fibrin formation and degradation as thrombosis in other venous locations 4

Clinical Implications

• While dorsal vein thrombosis of the penis (DVTP) is relatively uncommon, it represents a localized thrombotic process that would activate the coagulation and fibrinolytic systems 4
• The International Society on Thrombosis and Haemostasis recognizes that D-dimer elevation occurs with thrombotic events regardless of their anatomical location 1
• The degree of D-dimer elevation may vary based on the extent of the thrombosis and individual patient factors 1

Important Considerations and Limitations

• D-dimer testing has high sensitivity but low specificity for thrombotic events 1
• D-dimer levels can be elevated in numerous conditions other than thrombosis, including:
  • Advanced age 1, 5
  • Pregnancy 3
  • Active malignancy 3
  • Infection or inflammatory states 1
  • Recent surgery or trauma 1
• D-dimer assays vary in their sensitivity and specificity, with different cutoff values and reporting units across laboratories 1
• Sequential measurements may be required to confirm active fibrinolysis, as a single time-point measurement can be difficult to interpret due to D-dimer's long half-life 1

Clinical Application

• In a patient with suspected dorsal vein thrombosis of the penis, an elevated D-dimer would support the diagnosis but would not be diagnostic on its own 4, 3
• Imaging studies (such as duplex Doppler ultrasound) would be necessary to confirm the diagnosis of penile dorsal vein thrombosis 4
• A normal D-dimer has high negative predictive value and could help exclude thrombosis, but an elevated level would require further investigation 1

In summary, thrombosis of the dorsal veins of the penis, like any venous thrombosis, activates the coagulation and fibrinolytic systems, leading to the production of D-dimer as fibrin is degraded by plasmin. While not specific to this condition, D-dimer elevation would be expected in the presence of such thrombosis.