From the Guidelines
Elevated D-dimer levels can be caused by various conditions, including deep vein thrombosis (DVT), pulmonary embolism (PE), disseminated intravascular coagulation (DIC), recent surgery or trauma, pregnancy, cancer, infections, and inflammatory conditions, as well as COVID-19 infection, heart attacks, stroke, and severe liver disease. D-dimer testing is highly sensitive for ruling out thrombotic disorders, but it lacks specificity since many non-thrombotic conditions can also cause elevations 1. The causes of elevated D-dimer levels can be categorized into:
- Thrombotic disorders: DVT, PE, DIC
- Non-thrombotic conditions: recent surgery or trauma, pregnancy, cancer, infections, and inflammatory conditions
- Other conditions: COVID-19 infection, heart attacks, stroke, and severe liver disease According to the most recent study 1, COVID-19 infection has emerged as a significant cause of elevated D-dimer levels, often correlating with disease severity. The study found that patients with markedly raised D-dimers (three- to four-fold increase) were more likely to require critical care support. Therefore, it is essential to interpret D-dimer results alongside clinical presentation and other diagnostic tests to determine the underlying cause of elevated D-dimer levels. Normal aging also leads to higher baseline D-dimer levels, and D-dimer testing is not useful for confirmation of PE 1.
From the Research
Causes of Elevated D-Dimer
- Venous thromboembolism (VTE) is a major cause of elevated D-dimer levels, including deep vein thrombosis and pulmonary embolism 2, 3, 4, 5, 6
- Sepsis is another significant cause of elevated D-dimer levels, often associated with severe disease 2, 3
- Cancer is also a common cause of elevated D-dimer levels, particularly in patients with a high risk of VTE 2, 3, 4, 6
- Trauma and surgery can also lead to elevated D-dimer levels due to activation of the coagulation and fibrinolytic systems 2, 4
- Other conditions, such as COVID-19, can also cause elevated D-dimer levels, which may be associated with increased mortality and severity of disease 5
Disease States Associated with Elevated D-Dimer
- Pulmonary embolism is a common cause of elevated D-dimer levels, with a high prevalence in patients with extremely elevated D-dimer results 2
- Deep vein thrombosis is another disease state associated with elevated D-dimer levels, often requiring anticoagulation therapy 2, 4, 6
- Sepsis and cancer are also disease states associated with elevated D-dimer levels, requiring prompt diagnosis and treatment 2, 3
- Trauma and surgery can also lead to elevated D-dimer levels, requiring careful management and monitoring 2, 4