From Standard of Care
Cross-linked fibrin degradation product, which forms as a result of a breakdown of fibrin.
First step of formation thrombin cleavage exposes a polymerization site on fibrinogen that promotes binding of another fibrinogen or a monomeric fibrin molecule-fibrin monomers then bind to one another in an overlapping manner to form 2 molecule thick protofibrils.
The second step in its formation factor XIIIa covalently cross links fibrin monomers via intermolecular isopeptide bonds formed between lysine and glutamine residues within the soluble protofibrils and the insoluble fibrin gel.
The last step in formation, plasmin formed on the fibrin surface by plasminogen activation cleaves substrate fibrin at specific sites.
A wide variety of fibrin degradation products include the terminal degradation products of cross linked fibrin containing D-dimer and fragment E complex.
The antigen remains undetectable until released from cross-linked fibrin by the action of plasmin.
Indicates the presence of intravascular clot that has undergone lysis.
Useful test to exclude the diagnosis of venous thromboembolism.
High molecular weight fragments containing D-dimer are present in patients with DIC and other thrombotic disorders.
Assays measure an epitope on degradation products of factor XIIIa-cross linked fibrin.
Rules out 30% of patients with pulmonary embolism when used as a first-line test with a normal level and a low clinical suspicion of embolism.
A positive test result is not useful because elevated D-dimer level is found in 40-69% of patients which may be caused by infection or inflammation.
Elevated levels may be caused by disseminated intravascular coagulation, pulmonary embolism, advanced age, pregnancy, postoperative status, trauma, cancer, vasoocclusive crisis in sickle cell disease, myocardial infarction and inflammatory states.
A fibrin formation degradation product is essential for tumor angiogenesis and tumor growth.
Elevated in patients with solid malignancies including prostate, cervical colon and lung cancers.
Levels can be correlated with tumor markers Cancer 125 and CEA.
Levels correlate with the depth of cancer invasion and nodal involvement at the time of surgical resection.
Levels a predictor of overall survival in patients with metastatic colorectal cancer.
May have a role in gauging duration of the use anticoagulants in thromboembolic disease.
PROLONG study compared individuals with at least 3 months of treatment with vitamin K antagonists for unprovoked thromboembolic disease with continued anticoagulation or not based on d-dimer levels at one month after discontinuance of the oral anticoagulant.
PROLONG study revealed that a high recurrence rate of venous thromboembolism of 15% for patients with elevated d-dimer levels and not given further anticoagulation, while patients with high levels of d-dimer given continued anticoagulation has a combined risk of recurrent venothromboembolism and bleeding of 2.9%.
PROLONG study rate of recurrent thromboembolism for patients with normal d-dimer levels and no further anticoagulation was 6.2%.