Is a D-dimer (D-dimer test) level of 1.9, with a normal range of less than 0.5, considered elevated?

D-dimer Level of 1.9 with Normal Range <0.5 is Significantly Elevated

A D-dimer level of 1.9 μg/mL with a normal range of less than 0.5 μg/mL is significantly elevated and warrants clinical concern as it indicates active fibrin formation and degradation. 1

Clinical Significance of Elevated D-dimer

• D-dimer is a fibrin degradation product that results from the breakdown of cross-linked fibrin in blood clots, making it a marker of both coagulation activation and fibrinolysis 2
• A level of 1.9 μg/mL represents approximately 3.8 times the upper limit of normal, which falls into the category of a markedly elevated D-dimer 1
• D-dimer elevations of this magnitude are associated with increased risk for adverse outcomes including mortality and venous thromboembolism 3
• In studies examining D-dimer levels in various conditions, levels >0.5 μg/mL are consistently associated with pathological states requiring further investigation 1

Potential Clinical Implications

• This elevation requires further diagnostic evaluation as it may indicate the presence of:
  • Venous thromboembolism (deep vein thrombosis or pulmonary embolism) 1
  • Acute aortic dissection (studies show median D-dimer values of 1.80 μg/mL in confirmed cases) 1
  • Sepsis (associated with D-dimer elevations) 1
  • Malignancy (associated with D-dimer elevations) 4
  • Acute myocardial infarction (levels ≥0.71 μg/mL associated with higher risk of adverse events) 5

Diagnostic Value in Specific Conditions

• For acute aortic dissection:

  • Multiple studies demonstrate that D-dimer levels >0.5 μg/mL have a sensitivity of 94-100% 1
  • A negative D-dimer (<0.5 μg/mL) has excellent negative predictive value, but your value of 1.9 μg/mL is clearly positive 1

• For venous thromboembolism:

  • A level of 1.9 μg/mL is well above the 0.5 μg/mL threshold used to rule out VTE in low-risk patients 1
  • The negative predictive value of D-dimer <0.5 μg/mL for pulmonary embolism is approximately 99% 6
  • Conversely, your elevated level indicates increased risk and requires further diagnostic workup 1

Important Considerations

• D-dimer levels can be elevated in numerous non-thrombotic conditions:

  • Pregnancy (levels increase progressively, especially in third trimester) 1
  • Advanced age (levels rise with age, limiting specificity in those >80 years) 7
  • Recent surgery or trauma 2
  • Inflammatory states 2

• While extremely elevated D-dimer levels (>5000 μg/mL) are highly specific for serious illness (89% associated with VTE, sepsis, and/or cancer), a level of 1.9 μg/mL has lower specificity but still requires clinical attention 4

Clinical Approach

• This D-dimer elevation should not be dismissed, as it represents a nearly 4-fold increase above the upper limit of normal 1
• Further diagnostic evaluation should be guided by clinical presentation, risk factors, and symptoms 1
• For suspected VTE: imaging studies such as compression ultrasonography for DVT or CT pulmonary angiography for PE should be considered 1
• For suspected aortic pathology: appropriate imaging (CT angiography) should be considered 1

This level of D-dimer elevation indicates active pathological processes requiring further investigation and should not be ignored, even if the patient appears clinically stable.