From the Guidelines
Elevation of D-dimer levels can occur due to various conditions, including venous thromboembolism, sepsis, disseminated intravascular coagulation, malignancies, recent trauma or surgery, and acute myocardial infarction, as well as following fibrinolytic therapy 1. When considering the causes of raised D-dimer, it's crucial to recognize that this marker is not specific to any particular condition.
- The list of potential causes includes:
- Venous thromboembolism
- Sepsis
- Disseminated intravascular coagulation
- Malignancies
- Recent trauma or surgery
- Acute myocardial infarction
- Fibrinolytic therapy
- Other conditions such as pregnancy, cancer, severe infections, heart attack, stroke, and inflammatory conditions, as well as advanced age, liver disease, kidney disease, and strenuous exercise. Given the broad range of conditions that can lead to elevated D-dimer levels, clinical context is essential for proper interpretation of raised D-dimer results.
- D-dimer testing is most useful as a rule-out test for thrombosis when levels are normal, rather than as a diagnostic tool when levels are elevated, due to its high sensitivity but low specificity 1. It's also important to note that a negative D-dimer result does not completely rule out the presence of certain conditions, such as aortic dissection, especially in high-risk individuals, highlighting the need for comprehensive clinical evaluation beyond reliance on a single laboratory test 1.
From the Research
Causes of Raised D-Dimer
- Venous thromboembolism (VTE) is a major cause of raised D-dimer levels, including deep vein thrombosis (DVT) and pulmonary embolism (PE) 2, 3, 4
- Sepsis is another significant cause of elevated D-dimer levels, often associated with severe disease 2
- Cancer is also a common cause of raised D-dimer levels, with a high prevalence in patients with extremely elevated D-dimer results 2
- Trauma and surgery can also lead to increased D-dimer levels, due to activation of coagulation and fibrinolysis 2, 3
- Disseminated intravascular coagulation (DIC) is another condition associated with high D-dimer levels, often seen in critically ill patients 5
- Physiologic conditions such as aging, pregnancy, and strenuous physical activity can also cause increased D-dimer levels 6
- Infectious diseases and other disorders can also be associated with elevated D-dimer levels, highlighting the need for careful interpretation of test results 6