title: The use of D-dimer in specific clinical conditions: a narrative review.
abstract: The use of D-dimer in combination with a clinical decision rule has been widely investigated in pulmonary embolism and deep venous thrombosis. Although it has been shown to be safe in excluding venous thromboembolism, the clinician is often faced with specific situations in which the use of D-dimer is controversial. We review the best available evidence on these patients. We conclude that it is not safe to use D-dimer testing in patients with symptoms of a venous thromboembolism for over 14 days, patients receiving therapeutic heparin treatment and patients with suspected deep venous thrombosis during oral anticoagulant therapy. In these populations the levels of D-dimer can be lower then expected giving rise to false-negative results. It is safe to use D-dimer testing in combination with a clinical decision rule in patients of all ages, patients presenting with a suspected recurrent venous thromboembolism or inpatients with suspected pulmonary embolism. As patients with recurrent venous thromboembolism, elderly patients and inpatients have higher levels of D-dimer, D-dimer testing has a low specificity and the need for additional radiological testing is increased.
authors.affiliation: Diakonessenhuis, Department of Internal Medicine, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Bruinstroop
authors.forename: M A
authors.initials: MA
authors.lastname: van de Ree
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D