D-dimer

Also Known As

Fragment D-dimer

Fibrin Degradation Fragment

This article was last reviewed on

May 25, 2018.

This article waslast modified on September 16, 2019.

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 blood clot or a condition that causes inappropriate blood clots, such as deep vein thrombosis (DVT), pulmonary embolism (PE), or disseminated intravascular coagulation (DIC), and to monitor treatment of DIC and excessive clotting conditions

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

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Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

D-dimer is one of the protein fragments produced when a blood clot gets dissolved in the body. It is normally undetectable or detectable at a very low level unless the body is forming and breaking down blood clots. Then, its level in the blood can significantly 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 significantly rise when there is significant formation and breakdown of fibrin 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 cut-off 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 diagnostic procedures are required (e.g., ultrasound, CT angiography).

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 lower 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 affect more than 300,000 people 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.

Common Questions

How is the test used?
D-dimer tests are used to help rule out the presence of an inappropriate blood clot (thrombus). Some of the conditions that the D-dimer test is used to help rule out include:

Deep vein thrombosis (DVT)

Pulmonary embolism (PE)

Stroke

This test may be used to determine if further testing is necessary to help diagnose diseases and conditions that cause hypercoagulability, a tendency to clot inappropriately.

A D-dimer level may be used to help diagnose disseminated intravascular coagulation (DIC) and to monitor the effectiveness of DIC treatment.
When is it ordered?
D-dimer testing is often ordered when someone goes to the emergency room with symptoms of a serious condition (e.g., chest pain and difficulty in breathing).

A D-dimer test may be ordered when someone has symptoms of deep vein thrombosis, such as:

Leg pain or tenderness, usually in one leg

Leg swelling, edema

Discoloration of the leg

It may be ordered when someone has symptoms of pulmonary embolism such as:

Sudden shortness of breath, labored breathing

Coughing, hemoptysis (blood present in sputum)

Lung-related chest pain

Rapid heart rate

D-dimer is especially useful when a healthcare practitioner thinks that something other than deep vein thrombosis or pulmonary embolism is causing the symptoms. It is a quick, non-invasive way to help rule out abnormal or excess clotting as the underlying cause. However, it should not be used when the probability of pulmonary embolism is high based on clinical assessment.

When a person has symptoms of disseminated intravascular coagulation (DIC), such as bleeding gums, nausea, vomiting, severe muscle and abdominal pain, seizures, and decreased urine output, a D-dimer test may be ordered, along with a PT, PTT, fibrinogen, and platelet count, to help diagnose the condition. D-dimer may also be ordered at intervals when someone is undergoing treatment for DIC to help monitor its progress.
What does the test result mean?

A normal or "negative" D-dimer result (D-dimer level is below a predetermined cut-off threshold) means that it is most likely that the person tested does not have an acute condition or disease causing abnormal clot formation and breakdown. Most health practitioners agree that a negative D-dimer is most valid and useful when the test is done for people who are considered to be at low to moderate risk for thrombosis. The test is used to help rule out clotting as the cause of symptoms.

A positive D-dimer result may indicate the presence of an abnormally high level of fibrin degradation products. It indicates that there may be significant blood clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause. For example, it may be due to a venous thromboembolism (VTE) or disseminated intravascular coagulation (DIC). Typically, the D-dimer level is very elevated in DIC.

However, an elevated D-dimer does not always indicate the presence of a clot because a number of other factors can cause an increased level. Elevated levels may be seen in conditions in which fibrin is formed and then broken down, such as recent surgery, trauma, infection, heart attack, and some cancers or conditions in which fibrin is not cleared normally, such as liver disease. Therefore, D-dimer is typically not used to rule out VTE in hospitalized patients (inpatient setting).

Fibrin is also formed and broken down during pregnancy, so that may result in an elevated D-dimer level. However, if DIC is suspected in a woman who is pregnant or is in the immediate postpartum period, then the D-dimer test may be used, along with a PT, PTT, fibrinogen, and platelet count to help diagnose her condition. If the woman has DIC, her D-dimer level will be very elevated.

D-dimer is recommended as an adjunct test. Since D-dimer is a sensitive test but has a poor specificity, it should only be used to rule out deep vein thrombosis (DVT), not to confirm a diagnosis. It should not be used for pulmonary embolism when the clinical probability of that condition is high. Both increased and normal D-dimer levels may require follow-up and can lead to further diagnostic testing. People with positive D-dimer tests and those with moderate to high risk for DVT require further study with diagnostic imaging (e.g., CT angiography).

When used to monitor DIC treatment, decreasing levels indicate that treatment is effective while increasing levels may indicate that treatment is not working.
Is there anything else I should know?

D-dimer concentrations rise in the elderly, and false positives may be seen with high levels of rheumatoid factor, a protein seen in people with rheumatoid arthritis. D-dimer testing is not well studied in children.

There are several different methods of testing for D-dimer. The currently available D-dimer tests that yield quantitative results are typically done in a hospital lab. Since different tests are used in different units, the results of one cannot be extrapolated to another.
What are some common risk factors for inappropriate blood clotting?
Some risk factors include:

Major surgery or trauma

Hospitalization or living in a nursing home

Prolonged immobility—this can include long trips by plane, car, etc. or prolonged bed rest

Use of birth control or hormone replacement therapy

Broken bone, cast

Pregnancy or recent childbirth

Antiphospholipid syndrome

Certain cancers

Inherited clotting disorder such as factor V Leiden mutation

History of prior venous thromboembolism (VTE)

Obesity

Smoking
What other procedures might my healthcare practitioner order if my D-dimer is positive?

In an emergency room setting, if you are found to be at low to intermediate risk for thrombosis and/or venous thromboembolism and when you have a positive D-dimer test, your healthcare practitioner will likely order a non-invasive scanning procedure, such as a venous ultrasound, multi-detector helical computed axial tomography (CT), direct pulmonary angiography, or ventilation-perfusion (V/Q) scan. For more on these, see RadiologyInfo.org: Blood Clots.

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Health Professionals – LOINC

LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.

Listed in the table below are the LOINC with links to the LOINC detail pages.

LOINC	LOINC Display Name
48066-5	Fibrin D-dimer DDU (PPP) [Mass/Vol]
48058-2	Fibrin D-dimer DDU IA (PPP) [Mass/Vol]
71427-9	Fibrin D-dimer FEU IA (Bld) [Mass/Vol]
48065-7	Fibrin D-dimer FEU (PPP) [Mass/Vol]
48067-3	Fibrin D-dimer FEU IA (PPP) [Mass/Vol]
7799-0	Fibrin D-dimer Qn (PPP)
3246-6	Fibrin D-dimer IA Qn (PPP)
15179-5	Fibrin D-dimer Ql (PPP)
29280-5	Fibrin D-dimer LA Ql (PPP)
38898-3	Fibrin D-dimer (PPP) [Titer]

View Sources

Sources Used in Current Review

Weitz, J. et. al. (2017). A Test in Context: D-dimer. J Am Coll Cardiol. 2017;70(19):2411-2420. Available online at https://www.medscape.com/viewarticle/888540 Accessed on 5/05/18.

Lehman, C. et. al. (2018 Mary, Updated). Disseminated Intravascular Coagulation – DIC. ARUP Consult. Available online at https://arupconsult.com/content/disseminated-intravascular-coagulation. Accessed on 5/05/18.

Patel, K. and Chun, L. (2017 July 05, Updated). Deep Venous Thrombosis (DVT). Medscape Emergency Medicine. Available online at https://emedicine.medscape.com/article/1911303-overview. Accessed on 5/05/18.

Springel, E. and Malhotra, T. (2018 January 22, Updated). Thromboembolism in Pregnancy. Medscape Obstetrics & Gynecology. Available online at https://emedicine.medscape.com/article/2056380-overview#showall. Accessed on 5/05/18.

Reihani, H. et. al. (2018 February 11). Diagnostic Value of D-Dimer in Acute Myocardial Infarction Among Patients With Suspected Acute Coronary Syndrome. Cardiol Res. 2018 Feb; 9(1): 17–21.Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819624/. Accessed on 5/05/18.

Szigeti, R. (2014 December 10, Updated). D-Dimer. Medscape Laboratory Medicine. Available online at https://emedicine.medscape.com/article/2085111-overview#showall. Accessed on 5/05/18.

(2017 July 7, Updated). Know the Risks, Signs & Symptoms of Blood Clots. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/ncbddd/dvt/infographic-risk.html. Accessed on 5/13/18.

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.

(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.

(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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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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.

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. 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. Accessed August 2010.

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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. Accessed August 2010.

(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. 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.

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

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

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