108 - D-dimer: evidence based review and new applications

Autor(s): G. Palareti, C. Legnani

Issue: RIMeL - IJLaM, Vol. 5, N. 2, 2009 (MAF Servizi srl ed.)

Page(s): 108-112

D-dimer, a product of lysis of stabilized fibrin-clot, is a marker of coagulation activation. The use of the test has been shown of great clinical utility in the diagnostic work-up of acute venous thromboembolism (VTE) due to its high negative predictive value. The clinical usefulness of the test in other clinical settings (such as disseminated intravascular coagulation, arterial diseases, pregnancy, etc) is still debated. It has recently been shown that its levels tend to increase in some patients with a previous VTE episode after anticoagulation is stopped. Several prospective studies have consensually demonstrated that the rate of subsequent VTE recurrence is higher in those patients in whom D-dimer levels increase after anticoagulation is stopped. It can be said, therefore, that the D-dimer levels measured after anticoagulation is stopped can be used as a tool to stratify the individual risk of recurrence. A recent study, the collaborative, prospective, randomized (the PROLONG study, N Engl J Med 2006; 355:1780), tackled the problem whether or not D-dimer levels may also be useful to drive our decision on duration of anticoagulation in individual patients. The results of that study and other available data confirm that D-dimer assay, carried out after anticoagulation withdrawal, is an useful tool to assess the risk of recurrence and to regulate the duration of anticoagulation in individual patients with a first idiopathic VTE event.
Key-words: Fibrin fibrinogen degradation products, Pulmonary embolism, Venous thrombosis, Disseminated Intravascular Coagulation, Fibrin fragment D.

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