Role of fibrin D-dimer testing in emergency medicine.
OBJECTIVE
Systemic values of the fibrinolytic plasma marker fibrin D-dimer are raised in a variety of acute clinical conditions. D-dimer values can now be rapidly determined and used to aid diagnosis in emergency medicine. However, despite clinical guidelines, inappropriate and unnecessary measurement of D-dimer values is a significant clinical problem. An understanding of the pathophysiological basis and limitations of the value of D-dimer values may help reduce this problem. This review discusses the pathophysiology of the fibrinolytic system. The currently used assays, clinical indications, and limitations of D-dimer measurement are reviewed. Finally, the potential future clinical indications for measurement of D-dimer values in emergency medicine are discussed.


METHODS
Literature on D-dimer was identified from Medline, along with cross referencing from the reference lists of major articles on the subject


RESULTS
and conclusions: Systemic D-dimer values aids diagnosis, and is potentially a prognostic indicator, in a variety of clinical conditions in emergency medicine. However, it has limited specificity in patients with comorbid conditions. Although, currently, there is no standard D-dimer assay, immunoturbidimetric assays are the most suitable for use in emergency medicine
Wakai
A
A
Department of Emergency Medicine, Beaumont Hospital, Dublin, Republic of Ireland. wakai@indigo.ie
Gleeson
A
A
Winter
D
D
D015415:Biomarkers / Q000097:blood; D004635:Emergency Medicine / Q000379:methods; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis* / Q000502:physiology; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis; D020246:Venous Thrombosis / Q000175:diagnosis*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D