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D-dimer

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Also known as: Fragment D-dimer; Fibrin Degradation Fragment
Formal name: D-dimer
Related tests: Fibrin Degradation Products; FDP; Fibrin Split Products; FSP; PT and INR; PTT; Fibrinogen; Platelet Count

At a Glance

Why Get Tested?

To help rule out clotting (thrombotic) episodes and to help diagnose conditions related to thrombosis

When to Get Tested?

When you have symptoms of a thrombotic episode or a condition that causes acute and/or chronic inappropriate blood clot formation, such as deep vein thrombosis (DVT), pulmonary embolism (PE), or disseminated intravascular coagulation (DIC), and to monitor the progress and treatment of DIC and excessive clotting conditions

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

D-dimer is one of the protein fragments produced when a blood clot dissolves in the body. It is normally undetectable unless the body is forming and breaking down blood clots. Then, its level in the blood can rise. This test detects D-dimer in the blood.

When a blood vessel or tissue is injured and begins to bleed, a process called hemostasis is initiated by the body to create a blood clot to limit and eventually stop the bleeding. This process produces threads of a protein called fibrin, which crosslink together to form a fibrin net. That net, together with platelets, helps hold the forming blood clot in place at the site of the injury until it heals.

Once the area has had time to heal and the clot is no longer needed, the body uses an enzyme called plasmin to break the clot (thrombus) into small pieces so that it can be removed. The fragments of the disintegrating fibrin in the clot are called fibrin degradation products (FDP), which consist of variously sized pieces of crosslinked fibrin. One of the final fibrin degradation products produced is D-dimer, which can be measured in a blood sample when present. The level of D-dimer in the blood can rise when there is significant formation and breakdown of blood clots in the body.

For a person who is at low or intermediate risk for blood clotting (thrombosis) and/or thrombotic embolism, the strength of the D-dimer test is that it can be used in a hospital emergency room setting to determine the likelihood of a clot's presence. A negative D-dimer test (D-dimer level is below a predetermined threshold) indicates that it is highly unlikely that a thrombus is present. However, a positive D-dimer test cannot predict whether or not a clot is present. It indicates that further testing is required.

There are several factors and conditions associated with inappropriate blood clot formation. One of the most common is deep vein thrombosis (DVT), which involves clot formation in veins deep within the body, most frequently in the legs. These clots may grow very large and block blood flow in the legs, causing swelling, pain, and tissue damage. It is possible for a piece of the clot to break off and travel to other parts of the body. This "embolus" can lodge in the lungs, causing a pulmonary embolus or embolism (PE). Pulmonary embolisms from DVT cause as many as 300,000 deaths in the U.S. each year.

While clots most commonly form in the veins of the legs, they may also form in other areas as well. Measurements of D-dimer can be used to help detect clots in any of these sites. For example, clots in coronary arteries are the cause of myocardial infarction (heart attacks). Clots may form on the lining of the heart or its valves, particularly when the heart is beating irregularly (atrial fibrillation) or when the valves are damaged. Clots can also form in large arteries as a result of narrowing and damage from atherosclerosis. Pieces of such clots may break off and cause an embolus that blocks an artery in another organ, such as the brain (causing a stroke) or the kidneys.

Measurements of D-dimer may also be ordered, along with other tests, to help diagnose disseminated intravascular coagulation (DIC). DIC is a condition in which clotting factors are activated and then used up throughout the body. This creates numerous tiny blood clots and at the same time leaves the affected person vulnerable to excessive bleeding. It is a complex, sometimes life-threatening condition that can arise from a variety of situations, including some surgical procedures, sepsis, poisonous snake bites, liver disease, and after childbirth. Steps are taken to support the affected person while the underlying condition resolves. The D-dimer level will typically be very elevated in DIC.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Patel, K. et al. (Updated 2014 April 15). Deep Venous Thrombosis. Medscape. Available online at http://emedicine.medscape.com/article/758140-overview through http://emedicine.medscape.com. Accessed April 2014.

Ouellette, D. (Updated 2013 December 23). Pulmonary Embolism. Medscape. Available online at http://emedicine.medscape.com/article/300901-overview through http://emedicine.medscape.com. Accessed April 2014.

Mayo Clinic Staff (2014 February 22) Thrombophlebitis. Mayo Clinic. Available online at http://www.mayoclinic.com/print/thrombophlebitis/DS00223/DSECTION=all&METHOD=print through http://www.mayoclinic.com. Accessed April 2014.

Reviewed by Heikal, N. et al. (Updated September 2013). Disseminated Intravascular Coagulation – DIC. ARUP Consult. Available online at http://www.arupconsult.com/Topics/DIC.html?client_ID=LTD#tabs=1 through http://www.arupconsult.com. Accessed April 2014.

Pagana, K. D. & Pagana, T. J. (© 2012). Mosby's Diagnostic and Laboratory Test Reference 11th Edition: Mosby, Inc., Saint Louis, MO. Pp 338-339.

(© 1995–2014). D-Dimer Plasma. Mayo Medical Laboratories. http://www.mayomedicallaboratories.com/testcatalog/Clinical+and+Interpretive/9290 through http://www.mayomedicallaboratories.com. Accessed April 2014.

Szigeti, R. et al. D-Dimer. (Updated 2012 November 2). Medscape. Available online at http://www.emedicine.medscape.com/article/2085111-overview#a30 through http://www.emedicine.medscape.com. Accessed April 2014.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Disseminated Intravascular Coagulation Panel. AACC View Q&A [On-line information]. Available online at http://www.aacc.org/access/outcomes/18_disseminated_intravascular.stm through http://www.aacc.org/.

(2003 January). In Search of a Killer - Does D-dimer Help? American College of Emergency Physicians [On-line information]. Available online at http://www.acep.org/1,32394,0.html through http://www.acep.org.

(2001 July 17). Improving the Diagnosis of Pulmonary Embolism in the Emergency Department. Annals of Internal Medicine v135 (2) [On-line Journal]. Available online at http://www.annals.org/issues/v135n2/nts/200107170-00005.html through http://www.annals.org.

Strandness Jr., DE. Are Physical Findings Totally Useless In DVT/PE? Vascular Web, University of Washington School of Medicine [On-line information]. Available online at http://www.vascularweb.org/doc/54 through http://www.vascularweb.org.

Tan, J. (2000 December). Clinical Applications of the D-Dimer Assay in Deep Venous Thrombosis. San Bernardino County Medical Society Bulletin [On-line newsletter]. Available online at http://www.sbcms.org/southcalphysician/2000/nov-dec/art5.htm through http://www.sbcms.org.

Prazeres, G. Deep Vein Thrombosis - Part II. Internal Medicine MedStudents [On-line information]. Available online at http://www.medstudents.com.br/medint/medint5.htm through http://www.medstudents.com.br.

D-Dimer: Lifting the Veil of Confusion. Diagnostics today Online, Beckman Coulter [On-line information]. Available online at http://www.beckmancoulter.com/resourcecenter/diagtoday/articles/features/betterddimer.asp through http://www.beckmancoulter.com.

Began, T. (2002 October). Elisa D-Dimer: How Accurate For PE Diagnosis? PulmonaryReviews.com, vol 7 (10) [On-line information]. Available online at http://www.pulmonaryreviews.com/oct02/pr_oct02_ELISA.html through http://www.pulmonaryreviews.com.

Cortese Hassett, A. (2000 February). D-dimer Testing and Acute Venous Thromboembolism. Transfusion Medicine Update, The Institute for Transfusion Medicine [On-line information]. Available online at http://www.itxm.org/TMU2000/tmu2-2000.htm through http://www.itxm.org.

Titus, K. (2003 January). Identity crisis persists: which D-dimer? CAP Today, In the News [On-line Journal]. Available online at http://www.cap.org/captoday/archive/2003/0103/DdimerCover.html through http://www.cap.org.

Cruickshank, M. (2001 January). Practical Treatment Guidelines, Suspected DVT. The Thrombosis Interest Group of Canada [On-line information]. Available online at http://www.tigc.org/eguidelines/suspdvt.htm through http://www.tigc.org.

Abumuhor, I. and Hope Kearns, E.(2002 April 26). Thrombotic Thrombocytopenic Purpura, Differential Diagnosis. The Virtual Health Care Team [On-line information]. Available online at http://www.vhct.org/case2300/diagnosis.shtml through http://www.vhct.org.

Venous Thromboembolism (VTE), Qualitative (Time Sensitive). ARUP's Guide to Clinical Laboratory Testing (CLT) [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_250b.htm through http://www.aruplab.com.

Yen, S. (2001 March 27). D-Dimer For The Diagnosis Of Deep Vein Thrombosis. Internal Medicine Evidence Based Medicine Newsletter, Edition 8 [On-line Newsletter]. Available online at http://www.wshmc.org/wshcresidency/EBMNL/EBMNL032701.htm through http://www.wshmc.org.

Schreiber, D. (Updated 2010 June 10). Deep Venous Thrombosis and Thrombophlebitis. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/758140-overview through http://emedicine.medscape.com. Accessed August 2010.

Kamangar, N. and McDonnell, M. (Updated 2010 May 14). Pulmonary Embolism. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/300901-overview through http://emedicine.medscape.com. Accessed August 2010.

Mayo Clinic Staff (2009 January 30) Thrombophlebitis. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/print/thrombophlebitis/DS00223/DSECTION=all&METHOD=print through http://www.mayoclinic.com. Accessed August 2010.

(© 2008). Focus on Blood Clots. Vascular Disease Foundation [On-line information]. PDF available for download at http://www.vdf.org/pdfs/VDF_FocusOnBloodClots.pdf through http://www.vdf.org. Accessed August 2010.

Lehman, C. et. al. (Updated 2010 January). Disseminated Intravascular Coagulation – DIC. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/DIC.html?client_ID=LTD#tabs=1 through http://www.arupconsult.com. Accessed August 2010.

Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 347-348.

Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 332-333.

(April 2009) Hui S, Mast A, D-dimer: A non-invasive triage test for patients with suspected DVT. Clinical Laboratory News, Volume 35, Number 4. Available online at http://www.aacc.org/publications/cln/2009/april/Pages/series0409.aspx through http://www.aacc.org. Accessed November 2010.

(August 2006) Bussey H. What is the D-dimer test? ClotCare Online Resources. Available online at http://www.clotcare.com/faq_ddimertest.aspx through http://www.clotcare.com. Accessed November 2010.

National Blood Clot Alliance. Blood Clot Signs, Symptoms and Risks. Available online at http://www.stoptheclot.org/learn_more/blood_clot_symptoms__dvt.html through http://www.stoptheclot.org. Accessed November 2010.

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