D-dimers: a multi-faceted biomarker

Abstract

D-dimers are specific fibrin degradation products. They witness the activation of coagulation and secondary fibrinolysis. D-dimers are increased in many physiological (pregnancy, elderly subjects, etc.) or pathological (venous thrombosis, sepsis, surgery, etc.) clinical settings. For more than two decades, several D-dimer assay kits have been developed with some disparity in terms of analytical performance. However, a problem of standardization of this test persists. The value of D-dimers in the exclusion diagnosis of venous thromboembolic disease (VTE) and in the diagnosis of disseminated intravascular coagulation (DIC) is well established. In addition, the use of D-dimers for estimating the risk of recurrence of deep vein thrombosis is confirmed; however, its role in the decision to continue anticoagulation seems more controversial. Nevertheless, the field of application of D-dimers continues to expand, both for diagnostic and prognostic purposes as well in benign and malignant disorders. Since December 2019, marking the onset of the COVID-19 pandemic era, D-dimers have generated a lot of interest and new applications of this biomarker are supported. We present, here, an update on the analytical aspects and the main fields of application of this biomarker.