D-dimer is a terminal product of plasmin-mediated degradation of cross-linked fibrin and is a marker for the activation of both the coagulation and fibrinolytic systems. D-dimer is widely used in routine clinical practice to rule out venous thromboembolism (VTE), assess the risk of recurrent thrombosis, and determine the optimal duration of anticoagulant therapy, as well as for the diagnosis and monitoring of disseminated intravascular coagulation (DIC). The analytical methods for measuring D-dimer are high sensitive but relatively low specific, as D-dimer levels are elevated in several physiological and pathological conditions. The combination of D-dimer measurements with clinical probability scores allows for the safe exclusion of VTE. To improve diagnostic accuracy, several strategies have been proposed to increase the specificity of D-dimer testing. The application of age-adjusted and clinical probability adapted cutoff values for VTE allows VTE exclusion in a greater number of patients without the need for additional imaging studies.
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