REVIEW

Role of fibrin D-dimer testing in emergency medicine

A Wakai¹, A Gleeson¹, D Winter²

¹ Department of Emergency Medicine, Beaumont Hospital, Dublin, Republic of Ireland
² Department of Surgery, Beaumont Hospital

Correspondence to:
Correspondence to:
Dr A Wakai, Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Ireland;
wakai{at}indigo.ie

Objectives: Systemic values of the fibrinolytic plasma marker fibrin D-dimer are raised in a variety of acute clinical conditions. D-dimer values can now be rapidly determined and used to aid diagnosis in emergency medicine. However, despite clinical guidelines, inappropriate and unnecessary measurement of D-dimer values is a significant clinical problem. An understanding of the pathophysiological basis and limitations of the value of D-dimer values may help reduce this problem. This review discusses the pathophysiology of the fibrinolytic system. The currently used assays, clinical indications, and limitations of D-dimer measurement are reviewed. Finally, the potential future clinical indications for measurement of D-dimer values in emergency medicine are discussed.

Methods: Literature on D-dimer was identified from Medline, along with cross referencing from the reference lists of major articles on the subject

Results and conclusions: Systemic D-dimer values aids diagnosis, and is potentially a prognostic indicator, in a variety of clinical conditions in emergency medicine. However, it has limited specificity in patients with comorbid conditions. Although, currently, there is no standard D-dimer assay, immunoturbidimetric assays are the most suitable for use in emergency medicine

Keywords: D-dimer

Abbreviations: DD, D-dimer; VTE, venous thromboembolism; tPA, tissue plasminogen activator; XL-Fg, crosslinked fibrin; FDP, fibrin degradation product; ELISA, enzyme linked immunosorbent assay; HMW, high molecular weight; LMW, low molecular weight; FACT, Fibrin Assay Comparison Trial; CT, computed tomography; PE, pulmonary embolism; DVT, deep vein thrombosis; PTP, pretest probability; CHD, coronary heart disease; ACS, acute coronary syndrome; MI, myocardial infarction

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