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