REVIEW PAPER
Unreliability of d-dimers in diagnosis of venous thromboembolism – comprehensive literature review
1
Department of Clinical and Radiological Anatomy, Medical University, Lublin, Poland
2
Hospital of the Ministry of Interior and Administration, Lublin, Poland
3
Scientific Research Group of the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University, Lublin, Poland
4
University of Physical Education in Warsaw, branch in Biała Podlaska, Poland
Corresponding author
J Pre Clin Clin Res. 2023;17(2):85-90
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
D-dimers are mainly used in daily clinical practice to exclude venous thromboembolism (VTE); however, in a significant number of measurements, a positive D-dimer result does not confirm it, which is emphasized in the review. In addition, this parameter is often overused and its results misinterpreted.
Review methods:
A review and analysis of the most up-to-date literature (using the PubMed and Scopus databases, with over 90% of the works being no older than 8 years) consisting solely of English-language original and review papers addressing the topic of D-dimer testing in daily clinical practice.
Brief description of the state of knowledge:
Based on the literature review, it has been noted that D-dimers often produce false-positive results, which often leads to unjustified implementation of imaging diagnostics, which exposes the patient to ionizing radiation, contrast agents, administration of fibrinolytic drugs, as well as generating unnecessary costs. Modifying the D-dimer cut-off point in older patients and those with risk factors for VTE maintain negative predictive value (NPV) and specificity; however, there is still a large percentage of patients without VTE despite a positive D-dimer result.
Summary:
In the analyzed studies that included both the standard cut-off point and modified reference ranges for D-dimers based on age and likelihood of venous thromboembolism, a high percentage of patients with false-positive results were obtained, with limited specificity and positive predictive value (PPV).
D-dimers are mainly used in daily clinical practice to exclude venous thromboembolism (VTE); however, in a significant number of measurements, a positive D-dimer result does not confirm it, which is emphasized in the review. In addition, this parameter is often overused and its results misinterpreted.
Review methods:
A review and analysis of the most up-to-date literature (using the PubMed and Scopus databases, with over 90% of the works being no older than 8 years) consisting solely of English-language original and review papers addressing the topic of D-dimer testing in daily clinical practice.
Brief description of the state of knowledge:
Based on the literature review, it has been noted that D-dimers often produce false-positive results, which often leads to unjustified implementation of imaging diagnostics, which exposes the patient to ionizing radiation, contrast agents, administration of fibrinolytic drugs, as well as generating unnecessary costs. Modifying the D-dimer cut-off point in older patients and those with risk factors for VTE maintain negative predictive value (NPV) and specificity; however, there is still a large percentage of patients without VTE despite a positive D-dimer result.
Summary:
In the analyzed studies that included both the standard cut-off point and modified reference ranges for D-dimers based on age and likelihood of venous thromboembolism, a high percentage of patients with false-positive results were obtained, with limited specificity and positive predictive value (PPV).
FUNDING
Piech P, Komisarczuk M, Tuszyńska W, Staśkiewicz G, Węgłowski R. Unreliability of D-dimers in diagnosis of venous thromboembolism –
comprehensive literature review. J Pre-Clin Clin Res. 2023; 17(2): 85–90. doi: 10.26444/jpccr/165920
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