D-dimer levels can be elevated in many clinical circumstances, especially in hospitalized patients. D-dimer should not be used as an aid for exclusion of venous thrombosis or pulmonary embolism in pediatric patients in any circumstance and adult patients with6-8:

• Therapeutic dose anticoagulant administered for >24 hours before D-dimer is measured

• Thrombosis distal to the knee only

• Fibrinolytic therapy within previous seven days

• Upper extremity thrombosis

• D-dimer levels may be falsely negative if the elapsed time between thrombosis onset and D-dimer measurement is sufficient such that D-dimer has been cleared from the circulation.

The following conditions are associated with an increase in D-dimer concentrations, even in the absence of venous thrombosis:

• Aortic aneurysm

• Trauma or surgery within previous four weeks

• Disseminated malignancies

• Disseminated intravascular coagulation

• Sickle cell disease

• Sepsis, severe infections, pneumonia, severe skin infections

• Liver cirrhosis

• Pregnancy



    Wisdom is better than strength. Nevertheless the poor man's wisdom is despised. And his words are not heard. Words of the wise, spoken quietly, should be heard. Rather than the shout of a ruler of fools. 

    -Ecclesiastes 9:16-17

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