D Dimer Quantitative Test For Thromboembolic Disorders

When asked for their opinion on cancer tests, a lot of doctors say that, cancer blood tests and other lab tests are the first steps, which help a doctor to make a cancer diagnosis. The d‐dimer tests used in most diagnostic laboratories to screen for disseminated intravascular coagulation are latex agglutination assays which are not sufficiently sensitive to exclude venous thromboembolism ( Carter et al, 1993 ). Initial studies using enzyme‐linked immunoabsorption assay (ELISA) d‐dimer testing showed sensitivities and negative predictive values approaching 100% ( Bounameaux et al, 1994 ; vanBeek et al, 1996 ; Janssen et al, 1997 ). However, ELISA testing is not practical for use on a routine basis, particularly in an Emergency Room setting because batch testing is recommended and, consequently, results are not available in a timely fashion.

The diagnostic accuracy of interpretation of D‐dimer test results using higher thresholds in older patients is especially necessary, as has been reported by others ( Penaloza 2012 ). Future studies of the diagnostic accuracy of D‐dimer should contain analyses stratified according to the different age groups of patients studied.

19 The terminal digest of a crosslinked fibrin clot contains the fragment D-dimer-fragment E complex ( Figure 1 ). 20 However, the actual D-dimer antigen” detected by contemporary clinical assays is not necessarily the terminal digestion product of fibrin (ie, the fragment D-dimer-E complex), and for some clinical disorders has been shown to be high-molecular-weight soluble fibrin fragments that either have not entered a fibrin gel or are released before complete plasmin degradation has occurred ( Figure 2 ). 17 Detailed studies conducted by Francis et al 21 have shown that the fragment D-dimer-E complexes are formed after high-molecular-weight crosslinked fibrin complexes are released from an insoluble fibrin clot.

Altered D-dimer levels at 1 month after OAT withdrawal were associated with a higher rate of subsequent recurrence in all subjects investigated, especially in those with an unprovoked qualifying VTE event (hazard ratio, 2.43; 95% confidence interval, 1.18 to 4.61) and in those with thrombophilia (hazard ratio, 8.34; 95% confidence interval, 2.72 to 17.43).

Then, a new doctor came to see me before they made the final decision to discharge me. We talked and he seemed very concerned and ordered a CT d-dimer blood test with contrast to check for blood clots, even though the D-dimer was still negative. Due to the high risk of complications like pulmonary embolism, which can be fatal, urgent D-dimer testing, diagnosis and treatment are needed.

Harrison KA, Haire WD, Pappas AA, et al. Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus. At 3 months' follow-up, none of the after-implementation patients with negative D-dimer results were admitted for subsequent venous thromboembolic disease.